


^LIBRARY OF CONGRESS.? 

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^ [SMITHSONIAN DEPOSIT.] f 

J ^0^^ \ 

f UNITED STATES OF AMERICA.! 



ETHERIZATION; 



SURGICAL REMARKS. 



JOHN C. WARREN, M. D. 



Emeritus Professor of Anatomy and Surgery in the University at Cambridge ; 

Surgeon at Massachusetts General Hospital ; Honorary Member of the 

Medical and Chirurgical Society of London ; Corresponding 

Member of the Royal Academy of Medicine at Paris, and 

of the Academies of Naples, Florence, etc. 




BOSTON: 
WILLIAM D. TICKNOK & COMPANY, 

Corner of School and Washington Streets. 
M DCCC XLVIII.V. 



^1^ 



Entered according to Act of Congress, in the year 1847, by 

WILLIAM D. TICKNOR & CO. 

In the Clerk's Office of the District Court of the District of Massachusetts. 



BOSTON; 

PRINTED BY WILLIAM CHADWICK, 

No. 18, Exchange Street. 



WILLIAM APPLETON, Esq, President j 
Theodore Lyman, Esq, Vice President; 
Heney Andrews, Esq, Treasurer; 
Marcus Morton, Jr, Esq, Secretary: 



CHARLES AMORY, wILLIAM T. ANDREWS, 

NATHANIEL J. BOWDITCH. GEORGE M. DEXTER, 

ROBERT HOOPER, THOMAS LAMB, 

FRANCIS C. LOWELL, jqhN A. LOWELL, 

HENRY B. ROGERS, j. THOMAS STEVENSON 

J. WILEY EDMANDS, EDWARD WIGGLESWORTH, Esqs., 

Trustees of the MassacTimetts General HosxAtal : 

These pages are inscribed by the Author, as a respectful recognition of their 

interest in the introduction of Etherization into the Hospital, 

and also of their benevolent and judicious labors 

for enlarging the benefits of that 

noble Institution. 



A TEAR having elapsed since fhe introduction of ether into 
surgical practice, the period of enthusiasm has passed over, the 
trials of its influence have been innumerable, and the time has 
arrived for a dispassionate judgement of its value. These con- 
siderations might seem sufficient to have brought out the labors 
of some of the able and judicious persons, situated in the birth- 
place of etherization, who have had opportunity of experience 
in the ethereal practice. But, although many valuable produc- 
tions on this subject have appeated, none, I believe^have brought 
forward the fruits of our matured observation. 

The utility of a new publication has therefore been evident 
for some time. But this would not have been of sufficient 
weight to have induced me to undertake it, had not a direct ap- 
plication been made, and had I not been frequently c^alled to 
notice the slow progress of the practice of etherization in this 
country beyond the vicinity of its first introduction, compared 
with its rapid extension on the other side of the Atlantic. 



IV. 



The opportunity also of presenting some useful surgical ob- 
servations, of a practical nature, in connection with the results 
of etherization, contributed to decide me to give my experience 
of the effects of ether in preventing pain, incorporating such 
surgical remarks as naturally presented themselves. These 
are therefore not interpolations, but a part of the plan previ- 
ously laid out. 

As a preliminary to these remarks, a large number of cases 
was collected for the purpose of publishing the names, diseases, 
and phenomena in each individual. This could with propriety 
include only the names of hospital patients, and would give but 
partial and unsatisfactory results. The etherizations on which 
these remarks are founded, amounting to at least two hundred, 
have been done in the presence of gentlemen, qualified to judge 
of the accuracy of the particular and general statements, and 
therefore seemed to render the publication of individual names 
unnecessary. The introduction of the minute details of par- 
ticular cases, involving the repetition of appearances already 
well known to the public has also its objections. But we have 
thought it necessary to present a number of such cases, suffi- 
cient to display the effects of etherization in various operations 
and diseases. Por it seems impossible to exhibit in their 
proper light the effects of the new practice without the aid of 
particular historical details. 

Desirable as it would be to form a complete treatise on this 



subject, the difficulties of such an undertaking, it has seemed to 
me, could not readily be overcome, especially that arising from 
the succession of new facts afforded by daily experience. 
Another year of observation will, it is to be expected, produce 
the materials for a more systematic and comprehensive history' 
of etherization. 

A controversy has arisen as to the claim of priority in the 
introduction of ethereal inhalation. It is not my intention to 
enter into any investigation on this point, as it will perhaps be 
hereafter examined, and settled by some competent tribunal. 



ETHERIZATION: 



SURGICAL REMARKS. 



ETHERIZATION, ETC. 



I. 



What surgeon is there, wlio has not felt, while wit- 
nessing the distress of long painful operations, a sink- 
ing of the heart, to which no habit could render him 
insensible ! What surgeon ha.s not at these times been 
inspired with a wish, to find some means of lessening 
the sufferings he was obliged to inflict ! 

Such feelings have often operated on my own mind, 
and led to various trials with many different agents, 
with opium in all its forms, and other narcotics, even 
in such quantities as really alarmed me, without any 
satisfactory result. Mesmerism, and its mimic, neuro- 
logism, were offered by their advocates for this purpose, 
but never having the slightest faith in their physical in- 
fluence, their use could be admitted only as a possible 
means of producing insensibility to pain by acting on 
the mind of the patient ; and although such a state of 
mind can be sometimes produced, yet unhappily it 
never was in cases under my inspection. 

The discovery in these days of a property capable of 
so modifying the condition of the sentient organs, as 
1 



without injury to prevent tlie suffering produced by the 
division and laceration of the living textures, however 
desirable, was certainly unexpected. When such a 
property was found to exist in a well known substance, 
our surprise was increased, and we wondered at our own 
dulness in not having made the discovery before. 

The general properties of ether have been known for 
more than a century, and the effect of its inhalation in 
producing exhilaration and insensibility has been un- 
derstood for many years, not only by the scientific, 
but by young men in colleges, and schools, and in 
the shop of the apothecary, who have frequently em- 
ployed it for these purposes. 

The ethers diluted with water may be and have been 
administered by the mouth. They have the exciting 
and composing effects of inhalation, but the contact 
with the coats of the stomach of any large quantity of 
ether produces an excitement too great to justify its em- 
ployment for the purpose of composing in a decided 
and speedy manner. 

Many years have elapsed since I myself used ethe- 
real inhalation to relieve the distress attending the last 
stage of pulmonary inflammation. So long ago as the 
year 1805, it was applied for this purpose, in the case 
of a gentleman of distinction in the city,* very frequently 
since, and particularly in the year 1812, to a member 
of my family, who experienced from it great relief, and 
still lives, to give testimony to its effects. The manner 

* Thomas Davis, Esq., Formerly Treasurer of this Com- 
monwealth, who died in January, 1805. 



in which it was applied was by moistening a handker- 
chief and placing it near the face of the patient. 

A new era has opened to the operating surgeon ! 
His visitations on the most delicate parts are performed, 
not only without the agonizing screams he has been ac- 
customed to hear, but sometimes with a state of perfect 
insensibility, and occasionally even with the expression 
of pleasure on the part of the patient. Who could have 
imagined that drawing the knife over the delicate skin 
of the face might produce a sensation of unmixed de- 
light ! that the turning and twisting of instruments in 
the most sensitive bladder might be accompanied by a 
beautiful dream ! that the contorting of anchylosed 
joints should co-exist with a celestial vision ! If Am- 
brose Pare, and Louis, and Dessault, and Cheshelden, 
and Hunter, and Cooper, could see what our eyes daily 
witness, how would they long to come among us, and 
perform their exploits once more ! And with what fresh 
vigor does the living surgeon, who is ready to resign 
the scalpel, grasp it, and wish again to go through his 
career under the new auspices ! 

During the year which has passed since ethereal in- 
halation was first employed in surgical operations, an 
immense number of trials of its influence have been 
made in various parts of the world, with a success per- 
haps as uniform as that of any article employed in med- 
icine or surgery, and, what is more important, with as 
few ill consequences. , Originating in this country, and 
in this city, its application was immediately transferred 
to Europe, and hailed with delight by nearly all the 
eminent surgeons and physicians in England, France ,> 



Germany, and other countries. It lias been employed 
in ail kinds of operations, in a vast number of diseases, 
and althougb its effects have often appeared alarming, 
no satisfactory instance of fatal consequences has as 
yet been demonstrated. In estimating the danger we 
must also take into view the fact, that since the fear of 
pain has diminished the number of surgical operations 
has remarkably increased, at least in our vicinity. 

The first proposal to me for the employment of ether 
by inhalation, for the prevention of pain in surgical 
operations, was made by Dr. "W. T. G. Morton, about 
the middle of October, 1846. Calling on me, he stated 
that he had possession of a means of accomplishing 
this object, that he had made trials of its efficacy in the 
extraction of teeth, and that he wished me to test its 
power in surgical operations. The article used for this 
purpose not being mentioned, I supposed it was not 
proper for me to demand what it was, but I did think it 
necessary, before taking the responsibility of using it, 
or sanctioning its use, to ascertain whether a trial could 
be made without any apprehension of danger. Having 
satisfied myself on this point by various questions, I 
agi-eed to give Dr. M. the desired opportunity, as soon 
as it should be in my power. No such opportunity hav- 
ing occurred within a day or two in private practice, and 
being at that time in the performance of my tour of duty 
as attending surgeon at the Massachusetts General Hos- 
pital, I seized the occasion of the first operation in that 
institution for the proposed experiment. 

The patient was a young man, about twenty years old, 
having a tumour on the left side of the neck, lying par- 



allel to, and just below the left portion of the lower- 
jaw. This tumour, which had probably existed from his 
birth, seemed to be composed of tortuous, indurated 
veins, extending from the surface quite deeply under 
the tongue. My plan was to expose these veins by 
dissection sufficiently to enable me to pass a ligature 
around them. 

The patient was arranged for the operation in a sit- 
ting posture, and every thing made ready ; but Dr. 
Morton did not appear, until the lapse of nearly half an 
hour. I was about to proceed, when he entered hastily, 
excused the delay, which had been occasioned by his 
modifying the apparatus for the administration. The 
patient was then made to inhale a fluid from a tube con- 
nected with a glass globe. After four or five minutes he 
appeared to be asleep^ and was thought by Dr. Morton 
to be in a condition for the operation. I made an in- 
cision between two and three inches long, in the direction 
of the tumour, and to my great surprise without any 
starting, crying out, or other indication of pain. The 
fascia was then divided, the patient still appearing 
wholly insensible. Then followed the insulation of the 
veins, during which he began to move his limbs, cry out, 
and utter extraordinary expressions. These phenomena 
led to a doubt of the success of the application, and in 
truth I was not satisfied myself, until I had, soon after 
the operation, and on various other occasions, asked the 
question, whether he suffered pain. To this he always 
replied in the negative ; adding, however, that he knew 
of the operation, and comparing the stroke of the knife 
to that of a blunt instrument passed roughly across his- 
2* 



neck. Now tliat the effects of inhalation are better 
understood, this is placed in the class of cases of im- 
perfect etherization. 

On the following day, an operation for the extir- 
pation of a tumour from the arm was performed bj 
Dr. Hay ward, during which the patient exhibited no 
sign of physical or intellectual suffering. 

A few days after these first operations I was inform- 
ed by Dr. C. T. Jackson, a gentleman well known 
for his chemical and philosophical attainments, in a con- 
versation which took place between him, Dr. Augustus 
Grould, (the naturalist,) and myself, — that he first com- 
municated to Dr. Morton the inspiration of ether, as a 
means of preventing the pain of operations on the teeth. 
This I have already stated in the account of the first 
six cases of ethereal inhalation, written at the request 
of a gentleman who took great interest in the intro- 
duction of ether, R. H. Eddy, Esq., and published 
in the Boston Medical and Surgical Journal of De- 
cember 19, 1846. 

Anxious to extend the benefits of the inhalation to 
as many patients as possible, believing a peculiar ap- 
paratus necessary, and having the use of none ex- 
cepting that in the hands of Dr. Morton, I requested 
Dr. Charles Heywood, the house-surgeon of the Hospi- 
tal, who took an early and active interest in this matter, 
to procure a glass globe, and add to it the tube neces- 
sary for its application. At this period, however, I was 
checked by the information, that an exclusive patent had 
been taken out, and that no application could be made 
without the permission of the proprietor. The knowledge 



of this patent decided me not to use, nor encourage the 
use of the inhalation, until a more liberal arrangement 
could be made. Dr. Hay ward concurred with me, and 
having procured from Dr. Morton a letter of explana- 
tion to the surgeons of the Hospital, which was judged 
satisfactory, we felt ourselves justified in prosecuting the 
practice without restriction. 

From this time the use of ether was adopted in the 
operations at the Hospital by the various surgeons of 
the institution, Drs. Hay ward, Tovmsend, J. Mason 
Warren, Parkman, and H. J. Bigelow, as well as by 
myself, with uniform success, so far as its great object, 
the existence, or at least the recollection of pain was 
concerned, but with symptoms varying in degree from 
total insensibility to a knowledge of surrounding objects 
and passing events. I may also add with pleasure, 
that the physicians of the Hospital, Drs. Bigelow, Hale, 
J. B. S. Jackson, Bowditch, Holmes, and Fisher, gave 
their early attention to the subject, and uniformly and 
unanimously concurred in opinion with the surgical de- 
partment. Among other physicians of this place, who 
took an early and decided interest in this subject, I shall 
only mention Dr, James Jackson, late Professor of the 
Theory and Practice of Medicine, and Dr. A. L. Peir- 
6on, of Salem. In private practice successful applica- 
tions were immediately made in the presence of physi- 
cians, surgeons, and others, affording them the same 
satisfaction which we had experienced. 

Accounts of these wonderful performances were at 
once transmitted to Europe, by Drs. Ware, C. T. Jack- 
son, H. J. Bigelow, Morton and myself. 



8 



From that period to the present I have operated, and 
assisted in operations where ether was employed, in about 
two hundred cases, and have directed its use in a 
number of patients under my care where I was not 
present. To the information obtained from these ope- 
rations I have the advantage of adding a large number 
performed by my son, Dr. J. Mason Warren, the de- 
tails of which were furnished me as they occurred. 



II. 



The appearances presented by the patients under the 
influence of ether have a general resemblance : they are 
varied, however, by the constitution of the patient and 
the mode of application, so as to present exceptions, to 
an extent it would be useless to describe. 

The first inhalations were made through the tube and 
glass globe of Dr. Morton, afterwards a sponge, as ap- 
plied by Dr. Mason Warren in the cases of children, 
was used also in those of adults, found to be more safe 
and convenient than the tube, and therefore employed in 
the greater part of our practice.* 

The first symptom usually noticed is a short cough, 
which impels the patient to remove the sponge ; but being 
urged to allow it to be replaced, he readily consents, per- 
haps after a slight expectoration, and no severe pulmon- 
ary irritation being felt, he proceeds to inspire the va- 



^ Dr. Mason Warren first nsed the sponge for cliildren in 
February, 1847 — [see Boston Medical and Surgical Journal 
for March.] At about the same time it Avas used by Dr. 
Smith, a distingtiished pliysician of Cheltenham, EDghmih 
but does not seem to have been extensively employed by liin^ 
till the latter part of March, or first of April. 



10 



porons draught more and more deeply, until lie becomes 
insensible. The respiration is then often audible, and 
sometimes even apoplectic ; afterwards feeble and almost 
imperceptible — a state, which, however accustomed to 
it, excites a degree of uneasiness on the part of the sur- 
geon, and leads him to investigate more carefully the con- 
dition of the pulse. My own practice has been, when not 
doing the operation myself, to keep the fingers applied 
to the patient's pulse during the whole process of ether- 
ization. This, quickened from mental causes before the 
operation, is still more so a short time after inhalation, 
sometimes excessively ; subsequently it becomes slower, 
feebler, and even scarcely perceptible. When this is 
found to be the fact, the sponge being removed, the pulse 
becomes more free ; then, if necessary, being re-applied, 
the same phenomena may present themselves many times 
during a long operation. The pulsations of the heart 
are often hard and vibratory. The circulation in the 
capillaries, especially of the face, neck and upper part 
of the chest, is so much increased as to redden the skin, 
an appearance which rarely continues long, and gives 
place to paleness, succeeded by cold perspirations. 

The gastric phenomena are less remarkable. There 
is a propensity to nausea in a number of cases, which 
not unfrequently amounts to vomiting, sometimes pro- 
tracted to the following day. Relaxation of the vesical 
or intestinal sphincters does not ordinarily occur, but it 
is certain that in strictures an instrument may be more 
readily passed through the oesophageal and urethral 
canals in a state of etherization. 

In a female patient affected for many days with an 



11 



absolute retention of urine, etherization was followed 
by a free excretion, and the retention never returned* 
Whether in this case the relief was obtained by relax- 
ation of the vesical sphincter, or by tonic etherization 
of the vesical parietes, it really is not possible to say. 

The muscular apparatus is excited at an early period. 
The fists may be clenched, the muscles of the upper ex- 
tremities and neck contracted, sometimes cataleptically ; 
more commonly they perform various movements, as if 
the patient were trying to extricate himself from his 
new situation. Such movements are less frequently 
seen in the lower extremities. 

The conjunctiva of the eye is often injected with 
blood ; the pupils generally contracted, sometimes dilat- 
ed in a powerful etherization, frequently fixed. The 
eyelids are occasionally strained open, more frequently 
■closed ; and when closed, the patient, if still conscious, 
being called on to open them, has the power of doing so, 
thus affording a test, which, though by no means uni- 
versal, in some degree enables the operator to determine 
whether th^ operation shall begin. 

The most curious of the changes produced by ether- 
ization are those of the sensitive and intellectual func- 
tions; these changes, however, are exceedingly various 
in their form and order, but they usually terminate 
in a suspension of both sense and intelligence. In 
a number of instances tactile sensation, the sense 
of feeling, appears to be suspended, (as the patient 
has no recollection of suffering,) while the intellect 
exists. The organ of intellect seems capable of taking 
cognizance of objects external, while it either does not 



12 



notice the impressions on the feeling nerves, or if it does 
they do not produce on it the usual effects. 

These appearances, at first so astounding and unintel- 
ligible, seem to support the doctrine so satisfactorily ex- 
plained by Dr. Carpenter, in the British and Foreign 
Review, No. XLIY, and in return are illustrated and 
explained by this doctrine, viz. that the seat of tactile 
sensibility is in the great cephalic ganglia, while the in- 
tellectual functions reside in the cerebral lobes. If 
these lobes were, as formerly believed, the sensorium 
commune, or common centre of all impressions, as well 
as of intellectual functions, then it would be difficult to 
understand how common feeling, or tactile sensitiveness 
could be suspended, while intellect, and even visual and 
auditory sensibility continued. But if tactile sensitive- 
ness reside in the thalami, corpora striata, or annular 
protuberance, it is possible it may be suspended without 
suspension of the action of the cerebral lobes. So vis- 
ual sensation, residing ia the tubercula quadrigemina, 
may be, as we know it often is, intermitted without in- 
termission of intellect ; and the same may be said of 
the auditory function.* Hence arises a question not so 
satisfactorily answered, — why in some cases etherization 
should affect the seat of common feeling, i.e. the gan- 
glia, without in the same degree affecting the cerebral 
mass ? for these ganglia are not so situated, as to come 
under the ethereal influence through the circulation 
earlier than other parts of the encephalon. And if 
we admit that the influence is introduced through the 

^ Vide Appendix B. 



13 



nerves, then the par vagum, or pneumogastric nerves 
originating from the medulla oblongata would, we should 
expect, influence this part primarily, which thus being 
obnoxious to the first attacks of ether would experience 
an interruption of its function, and reacting on the lungH 
produce a suspension of respiration. This, we know, 
does sometimes happen, but generally in an advanced 
stage of etherization, and after the interruption of 
functions depending on other parts of the encephalic 
mass. 

Flourens, Longet, and other French physiologists, as 
appears by reports and discussions before the Royal 
Academy of Medicine in Paris, in March and April of 
the present year, and which are reported in the Paris 
Medical Gazette of Dr. J. Gruerin,* have been able by 
experiments on animals to satisfy themselves what partp 
of the brain are first etherized, and in what order the 
others follow. The course of my experience in human 
etherization is in favor of the opinion expressed by 
Professors Roux and Velpeau, that the symptoms are 
not so distinct, nor so regular, as to enable us to deter^ 
mine with precision which division of the nervous system 
will be first affected, and in what order the others. 

To illustrate the fact, that tactile sensation may be 
suspended without suspension of intellect, two or three 
cases may be mentioned, which are, of course, to be con- 
sidered as not exhibiting the most perfect phenomena. 
In the month of April, 1847, a medical gentleman 

* This journal was one of the earliest and most judicious 
supporters of the claims of etherization to public attention 

3 



14 



brought his wife to Boston from a great distance, for 
the removal of a scirrhous tumour under the influence 
of ether. The apprehension of pain had led her to ob- 
ject to the operation, until she became acquainted with 
the power of ether. She was thirty-five years of age, a 
lady of education, and what is usually Called a nervous 
person. Being placed in the upright posture inhalation 
was applied by the sponge. At first it caused some 
pulmonary irritation; she was soon after able to inhale 
freely, and showed marks of physical and mental excite- 
ment. She talked vrildly, cried, and sank down in her 
chair : she thought she was in the cars, and complained 
of the motion. The sponge was employed for fifteen 
minutes without signs of loss of intellect. Apprehen- 
sive of the effect of too long a use of ether, I deter- 
mined to begin the operation. 

To the incisions in the skin she exhibited no marks 
of sensitiveness, soon after cried out, and made consid- 
erable movements, which continued through the opera- 
tion. Her husband, an intelligent physician, pained 
and disappointed by her apparent suffering, considered 
etherization to be a failure. After all was concluded 
she expressed delight, that she had been relieved of 
her disease without pain ; and during the cure repeated- 
ly made use of the same expressions, exhibiting an un- 
usual cheerfulness caused by her escape from suffering. 

This lady could see, hear, answer questions, and 
understand the directions and persuasions addressed to 
her ; yet she uniformly said, that the operation had giv- 
en her no pain. It has been suggested, that in such 
cases the pain is not recollected; but the supposition that 



15 



one intellectual, i. e. cerebral, faculty is suspended, 
while the others continue, is more difficult than that 
of the suspension of the feeling-faculty independently of 
the intellectual. 

Soon after the above operation, a gentleman who re- 
sided at a great distance, came to Boston for the pur- 
pose of having a tumour removed. He informed me, 
that although usually in the enjoyment of good health, 
he was of a nervous temperament, and readily agitated 
by moral and physical impressions. Preparatory to the 
operation he was placed on a bed. The head being 
raised, a sponge was applied to the nostrils, and the 
mouth closed ; as it has appeared, that less cough is 
produced when the inhalation is through the nostrils. 
For five minutes he showed no external sign of etheri- 
zation; then said, ''now it is beginning," — ~" I feel it 
in the chest," — "now I feel it in the legs." Present- 
ly he began to speak rapidly, rose from the bed, and 
with many gesticulations uttered a harangue, partly on 
politics, partly on the medical profession, to which he 
was highly complimentary, but principally on the bles- 
sings which would flow to humanity from the discovery 
of etherization. This state was so gratifying, that with 
difficulty was he prevailed on to resume his place on the 
bed, and to reapply the sponge. In a few minutes 
more he closed his eyes, and believing him asleep, the 
operation was begun. Pie immediately spoke, encour- 
aged its prosecution, and in two or three minutes it was 
concluded. Thereupon he again broke forth in a highly 
poetical strain, described the delight he had experienced 
from the passage of the knife through the skin, the 



16 



gratification he felt at the different steps of the operation, 
and its happy conclusion. 

The symptoms of etherization continuing, I remained 
with him half an hour, during which he exhibited a 
variety of emotions, mostly of a pleasurable character, 
but terminating in a hysterical affection with a free dis- 
charge of tears. From time to time muscular tremors 
pervaded his whole system, especially the lower extrem- 
ities, without movements of the limbs. His wound, 
two or three inches in length, was perfectly united on 
the third day, and on the fourth he left Boston. 

In the latter part of May, 1847, another instance oc- 
curred, in which the intellectual faculties were awake 
through the whole operation, together with movements 
so strongly indicative of pain, that two very intelligent 
physicians present were satisfied the ether had been of 
no use, till after the operation, and at subsequent periods, 
they had an opportunity of questioning the patient 
themselves, with the uniform reply, that she had experi- 
enced no suffering. The disease was a tumour in the 
right breast, which, although it was only of five weeks' 
continuance, had attained the size of a lemon, and was 
rapidly increasing. It proved to be a dark-colored, 
vascular growth, of soft consistence, having the appear- 
ance of malignity, with the exception that its circumfer- 
ence was quite regular and separated from the glandu- 
lar texture in which it was buried, by a distinct, though 
very thin sac. 

This lady was forty-five years old, married, quite 
fleshy, but not remarkably healthy, and very excitable, 
or nervous, of course dreading the operation, and glad 



17 



to resort to the use of ether. The horizontal posture was 
employed, and the sponge applied to the nostrils ; in a 
few minutes her limbs became agitated, she talked a 
great deal, and displaced the sponge. More than a 
quarter of an hour elapsed before she became sufficiently 
tranquil to begin the operation ; and it would have been 
delayed longer, for the purpose of increasing the ether- 
ization, but that some apprehensions existed of its con- 
sequences in such a constitution. Similar apprehensions 
have frequently had a similar influence, until a more 
prolonged experience proved them to be groundless. 
The first incisions of the knife, pretty extensive, caused 
no movement. As the dissection proceeded, there oc- 
curred motions of the body and limbs, wild cries, pro- 
testations on the part of the patient of her great reso- 
lution and ability to endure suffering, frequent appeals 
to her physician to bear testimony to the fortitude with 
which she had supported various diseases, and strange 
dreamy expressions of apprehension from an operation 
she was expecting to undergo. With difficulty the mor- 
bid mass was extirpated from its connection with the 
mammary texture, and the operation was undoubtedly 
more protracted than it usually is in patients not ether- 
ized. There was much bleeding, and a number of arte^ 
rics were tied. 

The principal symptoms of etherization disappeared 
in about half an hour. The following day she was tran- 
quil and comfortable, with the exception of vomiting, 
which had continued from the time of the opei*ation, 
and declared she had not suffered but from the ligature 
of the arteries. The unmanageable state of this patient 
3 * 



18 



daring etherization caused at the time a sentiment of 
regret at its use ; but subsequently, when she expressed 
her great satisfaction at having escaped the dreaded 
pain, the ultimate conclusion was in favor of ether. 

To these cases many similar might be added, but I 
will only mention one, which did not occur in my own 
practice. A friend of mine, a lady, had three teeth 
extracted under etherization. She was perfectly able 
to count them as they were removed, but was entirely 
without pain during the extraction of the first two. 
Of course the seat of intellect was not etherized, while 
that of pain was, during these two operations. 

The phenomena of these cases support the opinion, 
that the seat of intellect and that of pain are different. 

The intellectual phenomena, while the cerebral func- 
tions are in a state of activity, though exceedingly va- 
rious, are principally of two kinds, — the gay, and the 
lachrymose. The former, most frequent in males; the 
latter in females ; in both the most prominent trait of 
character is apt to be displayed and exaggerated. In 
general; it may be said, that in most cases of etherization, 
there is a gradual increase of the cerebral excitement, 
till somnolence suddenly appears ; and on the return of 
intellect, this state, at first strongly marked, gradually 
fades into the ordinary condition of the mental faculties ; 
but to this course there are many exceptions. 

The young man, whether in a state of somnolence, 
or of excitement, has visions of rioting, travel, happy 
meetings with distant friends, and many enjoy the idea 
of the rapid motion of the rail-cars. A sea-captain made 
a voyage to Sumatra, and triumphantly repulsed a host 



19 



of Malays, who were assailing him with pikes and cut- 
lasses. Combativeness, attended with oaths and impre- 
cations, is sometimes developed in a degree troublesome 
and even alarming to those around. This disposition 
is frequently alternated with strong expressions of affec- 
tion and gratitude. 

The female exhibits hysterical phenomena. She has 
alternate fits of laughing and crying, though more dis- 
posed to the latter than the former ; and if married, she 
has dreams of her distant husband, or absent children. 
A female, who had exhibited restlessness during an 
operation, said, she dreamed that her child affected with 
hooping cough, and having a paroxysm of strangling, 
seemed neglected by her husband, who was unwilling 
to raise and support it. Indelicacy in expression or 
action has never presented itself in the range of my 
experience. 

The manifestations of passion are so numerous that 
it would be difficult to describe them all, but those enu- 
merated will perhaps be sufficient to convey a notion of 
their character. Pleasurable sensations seem on the 
whole to predominate ; and many patients, both male 
and female, are anxious to renew the gratification they 
have experienced. 



III. 



A question has arisen as to tlie channel through 
which ether passes into the system from the pulmonary 
organ; and specifically, whether it produces its effects 
through the medium of the nerves, or that of the blood 
vessels. In favor of the former opinion, is the rapidity 
with which it operates ; and its analogy, in this par- 
ticular, with the action of some poisons, supposed to 
exert their influence through the nervous system, as 
for example that of prussic acid applied to the mucous 
membrane of the tongue. If this influence is trans- 
mitted by the pulmonary nerves, the medulla oblongata 
through the par vagum would necessarily receive the 
first shock, as already suggested ; its functions would 
be suspended, and life irrevocably extinguished. Should 
it be objected, that the medulla could not be so power- 
fully affected by a retrograde nervous action through 
the pneumogastric nerves, the hypothesis falls to the 
ground. The other pulmonary nerves can hardly be 
supposed to form a channel of communication to the 
exclusion of the pneumogastric. The opinion may 



21 



perhaps be tested by experiment, yet it must be con- 
fessed it is hard to conceive that any such experiment 
should be quite satisfactory. 

The rapid introduction of ether through the vascular 
network spread in the pulmonary mucous membrane, is 
not difficult to understand. The immense surface form- 
ed by the pneumonic vesicles, the infinite number of 
capillaries spread through their parietes, the facility 
with which air and other fluids are imbibed by them, 
and the rapidity with which the blood, charged with 
these fluids, courses through the system, seem to afford 
a satisfactoiy answer to the proposed question. The 
principal difficulty appears to be in the last of these 
facts — the rapidity of the etherization compared with 
that of the circulation. "We have rarely seen any im- 
portant signs of etherization in a period short of two 
minutes. Now it is perfectly established by experi- 
ments mentioned by Muller, as having been performed 
by Mayer, (vide Muller's Physiology, vol. i. p. 239,) 
that on the introduction of a solution of the prussiate 
of potash into the lungs, the presence of this salt could 
be detected in the serum of the blood by the blue pre- 
cipitate produced by the addition of the sulphate of 
iron, as early as from two to five minutes. 

But laying aside this and all other experiments on 
animals, we are able to show the rapid course of the 
blood, by observations on the living human body many 
times repeated. In persons aflfected with chronic in- 
flammation of the prostate gland and of the mucous 
coat of the urinary bladder connected with it, for ex- 
ample, the introduction of a glass of wine into an 



22 



empty stomach will, in particular subjects, and es- 
pecially in those not accustomed to the use of wine, 
cause a painful irritation of these organs in less than 
three minutes. An observation of this fact in different 
persons, and of its frequent occurrence in the same 
person, allows no doubt as to its exactness. 

The internal pulmonary is vastly greater than the 
internal gastric suiface ; the tenuity of the mucous 
membrane of the former, greater than that of the 
latter ; and the disposition to imbibition much exceed- 
ing in the pulmonary that in the gastric surface. 
As ether received into the pulmonary blood, and 
sent to the left cavities of the heart, must be trans- 
mitted in a few seconds to the encephalic masses, there 
seems to be no difficulty in believing, that in two min- 
utes a sufficient quantity might be received to produce 
its peculiar effects. On the whole then, the opinion, 
that etherization takes place through the blood vessels, 
is the most satisfactory. 



lY. 



No powerful medicinal substance is without its mis- 
chiefs. Opium, antimony, quicksilver, and other vio- 
lent medicines, occasionally produce alarming and even 
fatal effects. That so active and volatile a fluid as 
ether, employed to produce a temporary abolition of 
the faculties of feeling and of intellect, should occa- 
sionally bring on dangerous symptoms, might naturally 
be expected. Perhaps the apprehensions arising from 
this cause have formerly checked the thought of em- 
ploying it in the way of inhalation. And hence, no 
doubt, when etherization was first introduced, judicious 
persons were of opinion so many alarming symptoms 
would follow its introduction into the pulmonary or- 
gans, that they were led to prognosticate a short reign 
to ethereal practice ; and we must confess, that a case 
of perfect etherization can rarely be witnessed, without 
a sentiment of uneasiness, and an anxiety to see the 
patient recover from his partial and temporary death. 

The most remarkable ill effects we have noticed are 
of two kinds > fii-st, those caused by the exclusion of the 



24 



oxygenous principle from the lungs; and second, those 
from excessive etherization of the nervous centres. 

1st. The ill effects arising from the exclusion of 
oxygen occurred in the early part of the ethereal prac- 
tice. Their occurrence led me to believe and to say to 
the medical class, that the interruption of the sensitive 
and intellectual faculties arose from asphyxia, — an 
opinion which has also been advanced and ably sup- 
ported by one of the most distinguished physiologists 
of the present time, M. Flourens, and by others. 
The appearances which led to this opinion were, an 
increased labor, and sometimes even a suspension of 
respiration, a dark color of the skin, a purple flow of 
blood from divided arteries, an increased fluidity of the 
blood, a difficulty in suspending haemorrhage, and a dis- 
position to its recurrence. When to these were added 
the loss of sense, both nervous and cerebral, and a 
deathlike coldness of the body, we were led to con- 
sider as present the phenomena of asphyxia, and to 
view them as constituting a formidable objection to 
the new practice. 

An accident of this kind occurred in an operation 
performed in November, 1846, for the removal of a 
tumour of the lower jaw in a female about forty years 
old. Etherization was effected rather slowly, and of 
course more ether was imbibed than in most cases ; but 
insensibility at last appeared, and the operation began 
without exciting any marks of pain. Soon after the 
patient uttered some cries, her respiration became con- 
vulsive ; a violent cough with symptoms of suflfocation 
followed; the skin became livid and cold, the arterial 



25 



blood dark colored, the respiration and pulse imper- 
ceptible ; and of course a strong apprehension was ex- 
cited, that life might be extinct. Under the use of 
stimulants, frictions, and change of posture, the vital 
actions reappeared, and the operation was satisfactorily 
finished. The haemorrhage was great, many arteries 
requiring ligature. In the course of that day, and 
even the following, there were fresh bleedings. Ulti- 
mately, the patient did well. 

About the same time, very similar appearances pre- 
sented themselves in a case of excision of a portion of 
the upper jaw. 

Such instances as these occurred, however, only in 
the early history of etherization, when the valved tube 
was employed to limit the entrance of atmospheric air, 
and produce a more exclusive inhalation of ether. As 
soon as the valve was removed, and especially after the 
introduction of the sponge, asphyxia ceased to occur, 
so that, in upwards of a hundred consecutive cases, 
there has not been more than a single instance^ and 
this of short duration. There are no longer to be seen 
those violent struggles for breath, purple hue of the 
blood, or difficulty in the suppression of hemorrhage. 
Of course we can no longer entertain the doctrine, that 
the state of etherization is a state of asphyxia. In the 
opinion of some, asphyxia is occasionally brought on, 
not by the substitution of ether for air in the lungs, but 
by the exclusion of the latter, in consequence of closure 
of the glottis from spasm of the laryngeal muscles. 

According to another doctrine, which has been ad- 
vanced, and which seems to be a modification of that 
4 



26 



of asphyxia, etherization produces its peculiar effect by 
a combination of asphyxia and intoxication. Ether, we 
know, at a high temperature having a strong affinity 
for oxygen, combines even with that of the atmosphere 
at the temperature of the lungs. According to the 
present theory, a part of the ether inhaled is capable 
of being decomposed by the pulmonary temperature ; 
and being decomposed, or in other words burnt, com- 
bines with the oxygen which should unite with the 
blood, and thus prevents its due oxygenation. The 
consequence will be, the circulation of a semi-oxygena- 
ted blood, an imperfect haematosis, and a partial as- 
phyxia. Another portion of ether is imbibed by the 
blood, and acting as a toxic principle, paralyzes the 
nervous system. However true the last part of this 
theory may be, the former will find a practical objec- 
tion in the fact frequently noticed in these remarks, 
that the phenomena of asphyxia are absent, when 
etherization is accomplished by the spoDge, or by any 
apparatus in which a sufficient quantity of atmospheric 
air is inhaled with the ether. 

There is a strong resemblance between etherization 
and alcoholization. Without entering into the discus- 
sion of a question, which for the want of a sufficient 
number of facts cannot be satisfactorily answered, we 
will simply say, the effects of alcohol are more gradual 
in their production, more slow in their disappearance, 
operate more decidedly on the cerebrum, and less on 
the sensitive faculties. 

2d. The principal known ill effect produced by ex- 
cessive etherization of the nervous centres, is a state of 



27 



general convulsions, without signs of asphyxia. This is 
sometimes so violent, as apparently to threaten life ; 
but by immediate suspension of the ether, and the free 
affusion of cold water, the convulsions cease, and do 
not recur. A young medical gentleman underwent an 
operation for a contraction of the hand, extended to 
about fifteen minutes. On the first inhalation, he had 
very agreeable visions, imagining he saw the twelve 
apostles, one of whom assured him, that the success of 
this operation would serve as an evidence of the truth 
of Christianity. This agreeable dream was interrupted 
by the strokes of the scalpel ; intelligence was restored ; 
he became very restless ; demanded more ether, and 
this being administered, insensibility returned, followed 
by a convulsion threatening the extinction of vitality. 
But on the free application of cold water, the frightful 
agitations ceased^ and permitted a satisfactory conclu- 
sion of the incisions. 

In a case of operation for the removal of diseased 
bone, at the Massachusetts General Hospital, at which 
were present among others two distinguished surgeons 
of New York, Drs. Stevens and Parker, the patient 
not being very susceptible to the action of ether, the 
application was continued from ten to fifteen minutes, 
and his stomach being well charged with food, he had 
first a violent vomiting, and soon after a general con- 
vulsion. This lasted a very short time, did not recur, 
nor was it followed by any ill consequence. Perhaps, 
in this case, the patient was overdosed ; and it might 
have been better in this, and may be in other similar 
cases, when the patient is unusually insensible to the 



28 



ethereal action, not to prolong the inhalation to a great 
extent. After all, the occurrence of convulsions is so 
very rare, that it must be considered an exception to a 
general fact, and to form no greater objection to ether- 
ization than the occasional overaction of many other 
articles of the Materia Medica. 

On the same day, in the presence of the same gen- 
tlemen, an operation was performed for the removal of 
a fibrous tumour near the knee joint, under a perfect 
etherization, without suffering, and without unpleasant 
symptoms. 

There are a few cases, in which ether renders the 
patient unmanageable ; and although most of them may 
be successfully treated by prolonged etherization, yet, 
when the proposed operation is not very painful, it 
seems best to relinquish the inhalation. In October, 
1847, a patient was to be operated on for the radical 
cure of an inguinal hernia. We did not wish to use 
ether, because the pain of the operation would be very 
slight ; but as he strongly demanded it, the sponge was 
applied for ten minutes, without any satisfactory effect. 
The inhalation being still continued, he became uneasy, 
and finally so ungovernable, that the operation was 
postponed. 

Other less important unfavorable symptoms might 
here be mentioned ; but as these vary excessively, and 
are stated in the different cases, it will be unnecessary 
to recur to them in this place. No instance of death 
in man from inhaling ether has occurred in our know- 
ledge, or belief. For although there have been a 
number of cases reported as fatal, yet in these the 



29 



connection between the cause and its supposed effect 
appears to be too imperfect to bear a close examination. 
Only one occurrence of this nature has happened here. 
A boy of very bad habits, whose arm was torn off by 
machinery, had an amputation at the shoulder-joint 
skillfully performed by Dr. Lewis on the day after 
the accident under etherization, and died in eight 
hours. 

Is there any thing remarkable in the death of a boy, 
in the habit of using spirituous liquors freely, from a 
laceration of the arm near the shoulder, requiring an 
amputation at the joint? How many surgeons have 
had the pain of witnessing the failure of a patient from 
the shock of a severe surgical operation ! Is it not 
wonderful, that among the hundreds of surgical opera- 
tions performed in this city under etherization, only 
one has had a fatal termination ? How many thousand 
have been executed in Europe within the ethereal 
period, and how few of the subsequent deaths have 
been imputed to this cause ! A number of these im- 
puted cases, so far as we have heard of them, may 
fairly be attributed to that terrible shock of the nervous 
system produced by a great surgical operation ; a prin- 
cipal part of which shock is in many cases the effect of 
the pain, which the virtue of ether prevents; and the 
others to different causes independent of ether. Those 
who have serious doubts as to these cases, will find 
their apprehensions relieved by the distinguished Mr. 
Traverses work on Constitutional Irritation, and the 
able article on Etherization in the British and Foreign 
Medical Review for April, 1847. 
4 * 



30 



We tMnk it then fair to say, that the numher of 
deaths from surgical operations after etherization, has 
not been greater than it would have been without. 
May it not be said even, that this number has been 
lessened by the exclusion of the shock from pain, which 
would have occurred, had it not been administered ? 

There are other ill effects, actual or supposed, which 
cannot in the present state of our knowledge be placed 
under either of the preceding heads. It has been 
said, that etherization breaks down, or dissolves the 
red globules, increases the fluidity of the blood, and 
diminishes its tendency to coagulate. Some of these 
consequences we have noticed as the result of asphyxia ; 
but that they do not ordinarily follow etherization, is 
fully shown by the fact, that, with the exception of 
three or four cases out of at least two hundred^ there 
has been no want of red globules, no tardiness in the 
coagulation, of course no tendency to excessive haemor- 
rhage, either primary, or secondary, no extraordinary 
fluidity of the blood, and no unusual delay in the healing 
process. An amputation of the thigh, detailed hereafter, 
with perfect etherization, performed by Dr. J. M. War- 
ren in July, 1847, was followed by a union of nearly 
the whole surface by plastic lymph, a little suppuration 
occurring at the place of the ligatures only. 

Among the other allegations against etherization, we 
have heard, that it may produce uterine haemorrhage 
and abortion. No facts in support of these charges, 
of a satisfactory nature, have come within our knowl- 
edge ; nor do we see reason to believe that there are 
any more grounds for them, than for those which might 



31 



be made against the use of a number of the most valu- 
able remedies of the Materia Medica. 

A more plausible objection is, that ether may be 
used too frequently ; that it may be employed to pro- 
duce a state of intoxication ; that it may be and has 
been administered to infants for very slight causes. The 
same objection may be made to opium, hyosciamus, the 
other narcotics, and to many other medicines. Ether 
has one advantage over many of these, that it cannot be 
introduced secretly, as its volatility diffuses it so widely 
that its presence is immediately detected. In regard 
to intoxication, it must be admitted, that it may be and 
has been employed for this purpose ; but so far as is 
known, it has rarely been habitually used, and is not 
likely to be, because there is no adequate pleasure at 
the moment of its reception, and because the exhilara- 
tion is too brief and too violent to become an object of 
strong and general desire. 

Another imputation against the practice, is its ten- 
dency to the production of chronic pulmonary affection. 
So vast is the number of instances, in which no pul- 
monary disease has followed, that it can hardly be neces- 
sary to combat the terrors of such an opinion ; for, even 
if disturbance in the pulmonary organ did sometimes 
occur, it ought to be considered as an extraordinary 
occurrence. If any of the supposed mischiefs actually 
arise, they would, from the nature of the application, 
be of an acute, rather than of a chronic character, and 
we should at once discover the evil, and shape our 
practice accordingly. Our experience has known no 
other derangement, either chronic or acute, than tran- 



32 



sient soreness of the chest in some delicate females, 
and in a single instance a cough, attributed to the ether 
without any sufficient reason. On the other side, it 
may be said, that ethereal inhalation is the most power- 
ful of known expectorants, and that it has, under our 
observation, proved very efficacious in chronic bron- 
chitis and spasmodic asthma. Nysten, more than thirty 
years ago, in the Diet, des Scien. Med. vol. xiii. 1815, 
recommended ' ' the inhalation of ether, as having been 
employed with advantageous effects in chronic catarrh, 
spasmodic asthma, and other diseases, respired for one 
or two minutes, and repeated five or six times in the 
day." 

In speaking of the dangerous effects of inhaling 
ether^ we have not alluded thus far to its employment 
by the dentist, because in his cases its application is 
usually more brief, and its introduction more limited. 
But as there must be, as has been shown, great differ- 
ences in the dispositions to be affected, and of course 
many instances of a necessarily prolonged application, 
we might reasonably expect to hear of a certain number 
of fatal terminations, if this is really a sufficient cause 
for their production. Now, we know that in the prac- 
tice of Dr. Morton and other dentists in this city, cases 
of etherization have amounted to some thousands. Has 
any one among us heard of a death from etherization 
after the extraction of a tooth ? We also must recol- 
lect the hundreds of thousands which have occurred in 
the great countries of Europe, and if we look into the 
foreign journals for the records of mortality in these 
cases, what will be the result ? 



33 



The Council of Zurich, for reasons we are not ac- 
quainted with, have prohibited the use of ether in the 
extraction of teeth. Probably, when they have had 
more experience of its innocuity, they will be disposed 
to repeal the prohibition, and allow their citizens the 
privilege of avoiding the pain of tooth-pulling. The 
use of ether in the removal of the crowns of the pri- 
mary teeth in children is certainly unnecessary, and 
therefore objectionable. 

An apprehension has arisen in France, that ether- 
ization may be employed in a criminal way, for the 
purpose of destroying life. During the state of sleep 
it is thought, that ether might be imperceptibly inhaled 
to a degree sufficient to prove fatal. Experiments on 
sleeping dogs have shown, that the toxic principle may 
be so gradually introduced, as, without producing ex- 
citation sufficient to arouse the animal, to cause a de- 
pression and extinction of the vital functions. An 
instance occurred in Edinburgh some time since, of 
a young woman found dead in her bed, without marks 
of violence, surrounded with fragments of a vessel of 
ether, and with a strong ethereal odor. The proof of 
death by etherization in this case is not perfectly satis- 
factory ; but the possibility of such an occurrence is 
rendered credible, not only by the experiments just 
mentioned, but by the well known effects of ether on 
the nervous system. The medical profession should 
therefore be aware of such a possibility, and make 
themselves acquainted with the consequent phenomena, 
in order to detect them. These would be the neoative 
symptoms from the absence of marks of injury, or dis- 



34 



ease ; the effluvia of ether, either external to the body^ 
or in the blood ; the appearances of cerebral excite- 
ment, such as injections and extravasations of the 
arteries, congestions of the veins, congestion in the 
lungs, injection upon the mucous coat of the stomach, 
and perhaps dark color in the blood. 

The phenomena of fatal etherization in the human 
body having been noticed in a single instance only, 
and those from experiments on animals not being ex- 
actly applicable to man, we must wait for future obser- 
vation to afford us such appearances, as might implicate 
the life of an accused individual. 

In order to prevent the criminal use of ether, it has 
been proposed in France to pass an ordinance, to pro- 
hibit the sale of ether excepting under the prescription 
of a physician. 

I feel obliged to mention another abuse for which 
this article may be applied. A recent Paris medical 
gazette contains an account of the administration of 
ether to a young woman by a dentist, who availed him- 
self of the state of insensibility for the accomplishment 
of an infamous purpose. The individual accused was 
in the hands of the police, but the trial not having 
come on, we are not yet informed what were the real 
facts. No physician or dentist should think of ether- 
izing a female, unless attended by one of her friends ; 
and no female should allow herself to be placed in this 
condition, without the attendance of such a companion. 



When tlie use of ether in surgical operations was 
first proposed, some distinguished physiologists and 
surgeons considered it as pernicious or useless. The 
most enlightened of these, guided by a philosophical 
spirit, investigated the matter for themselves, became 
satisfied by the amount of evidence which experiment 
yielded, and with the exception of a few, ultimately 
relinquished their objections, and adopted the practice. 
The natural obstacles to truths so very remarkable 
having given way, the doctrine poured like a torrent 
through all the countries of Europe. In this part of 
our country the apprehension of difficulties and dangers 
was immediately subdued by the accumulating host 
of successful experiments. Amputations, extirpations, 
the breaking down of anchyloses, the reduction of 
fractures and dislocations, and a multitude of other 
surgical manoeuvres painlessly executed, soon swept 
away all doubt. 

In order to form a proper estimate of the value of 
the new practice, we should endeavor to realize the men- 



36 



tal condition whicli precedes a surgical operation. As 
soon as a patient is condemned to the knife, what ter- 
rors does his imagination inflict ! how many sleepless 
nights, and horrible dreams, and sinkings of the heart 
does he experience ! what apprehensions of dangerous 
bleedings, of wounds of vital parts, and even of sudden 
death does he paint to himself I And when to these is 
added the dread of insupportable pain, what a frightful 
picture presents itself to his mind ! No wonder that 
many persons are unable to bring themselves to submit 
— no wonder that some, wrought to desperation, are 
led to anticipate their sufferings by a voluntary death. 
Horror of the knife led a gentleman in this city afflicted 
with a stone in the bladder to commit suicide. When 
the terror of corporeal suffering is taken from this load 
of apprehension, the patient may indulge a hope, which 
leads him to submit cheerfully to uncertain dangers. 

Amputations. — In amputations, since ether has been 
employed, we have never had the unhappiness to wit- 
ness an instance of the agonizing screams, before so 
painful to our ears. A few minutes of inhalation have 
caused the patient imperceptibly to glide through these 
operations. 

An amputation of the thigh was done by Dr. J. M. 
Warren, July 14, 1847, on a patient filled with ap- 
prehensions, and barely recruited from the effects of 
a distressing accident. Five minutes of etherization 
threw him into a profound insensibility, from which he 
shortly awoke to discover that his limb was removed, 
without any accompanying sentiment but a dream of 
delightful strains of music. In this case, as in many 






37 



others, one of those phenomena occurred, which has 
been already pointed out. The femoral artery was tied 
without any movement ; ligature of the smaller arteries 
caused a shrinking, as from pain ; when a sponge was 
passed over the large muscular flaps, cries and violent 
startings were elicited. Yet this man declared after- 
wards, that, although he knew when these last opera- 
tions took place, none of them were attended with any 
painful sensation. He slept soundly all that night and 
on the next day was seen sitting up in bed^ reading 
the newspaper, as if nothing unusual had occurred 
to him. 

An amputation for an accident necessarily fatal ex- 
hibits not less distinctly the propriety of the practice. 
A laborer whose limb had been crushed by the wheel of 
a rail car, was brought to the Hospital in a mutilated 
state, and it was judged that the only hope of safety 
rested on a speedy amputation. His ignorance, stu- 
pidity, and state of intoxication, led him obstinately to 
refuse to submit, and all the means of persuasion hav- 
ing been exhausted, it became necessary to leave him 
for the night. On the following morning having rallied 
a little under the use of stimulants he was etherized, 
carried to the theatre, his mangled limb removed and 
dressed. He survived three days, and on the morning 
of the third, informed his relations, standing at the bed- 
side, that the doctors had wished to amputate his limb, 
but that he had refused to give his consent, and died 
soon after, apparently without knowing it had been re- 
moved. 

At least twenty amputations have been done under 
6 



38 



our eyes without the slightest pain, and generally inth 
rapid recoveries. 

Extirpations. Of the numerous instances of par- 
tial or total extirpation of the mammary gland two 
have been already described, both belonging to the 
class, in which, while intellect continued, the patient 
declared there had been no pain. We will here specify 
a perfect case attended with some peculiarities, in which 
pain and intellect were equally suspended. 

A married lady, of delicate constitution, submitted 
to my examination, a tumour of the right breast, two 
years ago. So small and irregular was it, that any ap- 
prehension of its terminating in a malignant affection 
appeared groundless, and she was therefore advised not 
to think of it. Gradually, however, it increased, be- 
came tender, painful, quite hard, and exciting much 
anxiety, its removal was ultimately advised, and was 
accomplished in May, 1 847 . Etherization by the sponge 
was perfectly effected in two minutes. The tumour 
removed was found to be hard, not scirrhous, insulated 
by a sac, and the patient awoke from an agreeable dream 
with the satisfaction of having been relieved without 
her cognizance. Ether has been thought to be contra- 
indicated where there is a tendency to cephalic derange- 
ment ; but in this case, a headache, to which for some 
years this lady had been a victim, was suspended till 
five days after the operation, and then recurred without 
unusual severity. The immense benefit from avoiding 
the shock of severe pain on the nervous system in so 
delicate a person was considered as more than a balance 
for a transient pulmonary inconvenience. 



39 



Anchylosis, as a frequent consequence of fracture 
near or in an articulation, is distressing to the patient, 
and often embarrassing to the surgeon. The most happy 
results from ether have occurred in a number of these 
cases, and the bad consequences of this sequel may be 
considered as less formidable than they used to be. The 
great suffering from tearing away the newly-formed ad- 
hesions, and the apprehension of subsequent inflammation 
have often prevented the application of the force neces- 
sary to restore the movements of the disordered limb. 
This may frequently be accomplished in the most satis- 
factory manner without pain, and so far as our present 
experience extends, without that degree of inflamma- 
tion, which is known to have frequently followed this 
practice. 

Dr. Bell, the able superintendent of the McLean 
Asylum, a department of the Massachusetts General 
Hospital, conducted to the latter institution a young 
lady, who had two months before met with a severe in- 
jury of the left elbow, followed by a loss of the rotatory 
movements of the hand, and in a great measure of flexion 
and extension of the fore-arm. After an examination in 
the presence of my colleagues, I judged the accident to 
be a dislocation of the upper extremity of the radius on 
the external condyle of the os humeri, and in this opin- 
ion Dr. Hayward agreed after examining the arm. 

The patient and her friends were then informed, that 
the movements of the joint might be improved by fre- 
quent and long-continued efforts of rotation of the hand 
and flexion of the fore-arm ; that the more certain and 
perfect method of attaining these objects was by forcible 



40 



rotation of the radius with violent flexion and exten- 
sion of the fore-arm, but that this last practice would 
be attended with very severe pain. While we were 
still doubting which course to pursue, the thought of 
etherization occurred, and was suggested to the patient, 
who with the advice of Dr. Bell immediately assented 
to it. A sponge was used, and in two minutes she was 
asleep. Seizing the lower extremity of the os humeri 
with the left hand, with the right a combined movement 
was accomplished of rotation of the hand outwards, 
elongation of the fore-arm and extension or straighten- 
ing of the elbow-joint. By these means the head of the 
radius was brought into its place ; then by a forcible 
flexion of the fore-arm the remaining adhesions were 
broken down with a distinct crackling. 

No motion or sign of pain was exhibited. In two 
or three minutes the patient awoke smiling, as if some- 
thing agreeable had passed through her mind. She 
was then asked, whether she felt disposed to an ope- 
ration for the relief of her arm, to which she replied 
affirmatively. Being desired to make such movements 
as she was able, she raised the arm, and to her great 
surprise and gratification found all its movements re- 
stored. She got well without any important inflam- 
mation. 

A female patient in the Hospital, who had recovered 
from a fracture of the surgical neck of the os humeri^ 
having a consequent inability to elevate the arm above 
a horizontal line, was etherized by Br. H. J. Bigelow, 
whose patient she was, and he then politely invited me 
to operate on the arm. The scapula being firmly sup^ 



41 



ported, the os humeri was gradually elevated till it 
came in contact with the side of the head, with an au- 
dible rupture of the adhesions. Anterior, posterior and 
rotatory movements were then freely made — all without 
the slightest shrinking, and the patient awoke with a 
smile. This occurred in the presence of Dr. Page, of 
Philadelphia, Dr. Smith, of the Navy Yard at Charles- 
town, and other gentlemen. 

The son of my gardener falling from a tree fractured 
the internal condyle of the os humeri, and dislocated 
the fore-arm. The dislocation was reduced by Dr. Wild , 
Jr., of Brookline, under whose judicious treatment the 
violent inflammation which followed was subdued, and 
at the end of a month the limb was restored nearly to 
its natural size. The severe articular inflammation was 
followed, as it usually is in such cases, by partial an- 
chylosis. The boy was unable to move the arm more 
than four or five degrees. Finding that his condition 
did not improve, it was agreed in a conference with 
Dr. Wild, that the adhesions should be broken down 
under the influence of ether. 

At the end of seven weeks from the accident the pa- 
tient was brought to my house by Dr. Wild, and the 
operation was performed with his aid : Drs. Wyman, 
Parkman, and J. M. Warren, were present. Etheriza- 
tion was slowly effected, the application of the sponge 
being required for about ten minutes. The upper arm 
being firmly held, I operated with the fore-arm as a le- 
ver, and produced forcible flexion. The resistance was 
so great, that at first it seemed impossible to overcome 
it, but by continual efforts it yielded with a loud craok« 
5 * 



42 



ling, which almost alarmed us. The fore-arm was 
brought to extreme flexion^ and then to extreme exten- 
sion without any emotion of the patient. 

After his recovery from etherization he had much pain 
till the next day, and the swelling seemed to call for 
the application of leeches. But before they were ap- 
plied it subsided, and he had subsequently no unpleas- 
ant symptoms. Under the persevering use of passive 
movements the limb is gradually recovering. The dis- 
, position to regeneration of the adhesions in such cases, 
and the consequent stiffening of the joint, often render 
a repetition of this process unavoidable. 

The common treatment of fracture of the condyles 
of the OS humeri is by the application of close splints 
and bandages ; and I would remark, (not in reference 
to this case, which was treated exactly as it should 
have been) that the practice generally recommended is 
pernicious, because it is adapted to favor the worst 
consequence of this accident, namely a loss of the pow- 
er of bending the elbow. 

Every surgeon knows, that when a fracture extends 
into a joint, the effusions of cartilaginous and osseous 
substance, and the adhesions they produce in and about 
the articulation, impair its motion in a greater or less 
degree. To prevent this ill consequence it is advised 
to take off the splint, and move the arm, at the end of 
two weeks ; but in the mean time the causes above men- 
tioned, with confinement of the limb, render the move- 
ment so painful, that the patient resists the operation, 
and for a time it is abandoned. On the next attempt 
these difficulties are still greater. It is therefore thought 



43 



better to leave the limb to itself till the inflammation has 
wholly subsided, but motion cannot at this period be 
accomplished without violence. Further it may be said, 
that where there is no dislocation, there is no need of 
splints, nor bandages. The fractured condyle, if dis- 
placed, cannot ordinarily be restored to its proper situa- 
tion, and splints are not required to retain it in its new 
position, for it will retain it without them. 

The practice in this accident should consist in appli- 
cations destined to prevent inflammation, as leeches, 
cold water, etc. The arm should be left free from 
every impediment to its movement, and when the in- 
flammatory symptoms are not alarming, the patient 
should be compelled to give it motion in three or four 
days after the injury. 

A young man appeared at the Hospital having an 
ununited fracture of the thigh with two inches of short- 
ening, the result of an accident which happened two 
months before. An extending apparatus was adjusted, 
the patient etherized, and extension being made, the 
limb was elongated. By the continuance of the process 
the natural length was restored, with the exception of 
half an inch, and a firm union was obtained. Notwith- 
standing various precautions, the long confinement of 
the limb in one posture was followed, as frequently hap- 
pens, by absolute immobility of the knee-joint. Ether- 
ization was employed^ and then requesting my colleague. 
Br. Townsend, to grasp the lower part of the thigh-bone^ 
I made forcible flexion till the les: ^nd this-h came in 
contact. This was accompanied with a crepitation so 
loud, as to be heard throughout the ward. In a quar- 



44 



ter of an hour after I found the man in a violent fit of 
crying, from the impression that his bone had been 
again broken. On the following day he had recovered 
from his apprehension, and experienced only a moderate 
degree of pain and swelling. He soon regained the 
use of his limb, and was able to walk with a slight halt. 

In rupture of the adhesions from anchylosis a great 
advantage is gained from the state of insensibility, be- 
cause it prevents the patient from a natural and involun- 
tary counter-effort of muscular contraction, in order 
to resist a movement he knows will give pain. It 
may be said, that in all these cases the application of 
force is unnecessary, because the use of the articulation 
would be gradually acquired without it. But besides 
the loss of time, amounting to weeks, perhaps to months, 
it is doubtful, whether so much motion would ever be 
recovered, as may be at once attained by the immediate 
destruction of the adhesions. 

Fractures in general do not require the application 
of great extending force for their reduction. In some, 
however, the limb being shortened by muscular contrac- 
tion, the resistance thus opposed cannot be overcome by 
physical force without a violence both painful and dan- 
gerous to the patient. Fracture of the thigh affords an 
example. In this accident, the broken pieces are com- 
monly displaced and overshot, partly from the circum- 
stances of the injury, and partly from the obliquity 
common to this and most fractures of the long bones. 
The overlapping bones must be brought to correspond 
at their extremities, in order to prevent shortening, de- 
formity, and difficult union ; but this is opposed by 



45 



the powerful contraction of irritated muscles. Ether 
enables us to annihilate these contractions, and bring 
the limb without pain to its proper situation. 

The patient having been put to sleep, the surgeon 
extends the limb, brings the fragments to their natural 
relations, applies permanent extension and counter- 
extension, and supports the whole limb by lateral 
pressure, especially about the fractured part ; if after- 
wards displacement occurs, he repeats the same process. 
At the end of five or six weeks, he attempts to over- 
come the stiffness of the knee-joint by flexion of the 
leg, and when, as often happens, this cannot be accom- 
plished without severe pain, it can be done most happily 
in the etherized state. Nearly the same method may 
be pursued in the treatment of fracture of the neck of 
the thigh bone. 

In overshot ununited fractures of some duration, the 
difficulties are greater, but even these may be overcome 
if too long a period since the fracture has not elapsed. 
This is shown by the case last described, (page 43,) and 
another may here be adduced with circumstances some- 
what different. 

In the winter of 1847, a man met with a fracture of 
the upper third of the thigh bone, with a shortening 
of between two and three inches, and an anterior projec- 
tion of the upper fragment. Great pains were taken 
to restore the length of the limb, and remove the de- 
formity. The straight posture, the flexed, the apparatus 
of Jarvis and bed of Amesbury were successively 
tried ; but all these plans were abortive, because the 
patient could not bear the requisite pressure, and two 



46 



months elapsed without union. After a little respite, 
to allow the healing of excoriations, etherization was 
resorted to, the limb brought down by an extending 
apparatus, and the same process repeated, when the 
bones became displaced at various times afterwards ; 
compression also was applied to the upper fragment, 
and a cure accomplished with a very slight shortening. 

Whether the sensitiveness of this man was modified 
by the inhalation, or by any other cause, we pretend 
not to say. Certain it is, that after the first application, 
he never suffered severely, and we were all struck with 
the fact, that this man, so irritable before etherization, 
became quiet and docile afterwards. 

Dislocations. — The advantages obtained by mus- 
cular relaxation in fractures, as noticed above, are equ- 
ally great in the reduction of dislocations, since the 
principal impediment in these cases arises from the 
same cause. It is therefore scarcely necessary to illus- 
trate them by other facts. But it may be stated, that 
two cases of dislocation of the os humeri were imme- 
diately reduced by Dr. Parkman, one of the surgeons 
of the Hospital, under the influence of ether, one of 
which had already resisted powerful efforts for reduc- 
tion without ether. We have great hopes of hereafter 
seeing some of the difficult dislocations of the hip and 
shoulder, hitherto the opprobria of surgery, compelled 
to submit to the power of ethereal relaxation. 

The remarks before made on the muscular relaxation 
from ether satisfactorily show, that by it we produce a 
condition of the muscles, which permits extension with 
a moiety of the power otherwise required. 



47 



Opekations on the bones. — The bones are tbe sub- 
jects of severe, long-continued operations, from the 
shock of which the patient sometimes sinks. Three 
instances of operations on the bones may be noticed, 
happily conducted by the aid of ether. 

First, a necrosis of the tibia of two years standing 
was submitted to the hands of Dr. Townsend, while 
knowing that the etherization must be carried to a great 
extent, I carefully watched its effects. An incision of 
six or seven inches, a number of sections of the en- 
closing new bone, and the removal of many portions 
of sequestra required a period of forty-five minutes. 
Etherization by a sponge was continued with very 
slight interruptions for thirty minutes without suffer- 
ing, but the patient's pulse failing at the end of this 
period, it was intermitted, and he awoke soon after. 
Immediately he became very restless, and with many 
odd remarks, clamorously demanding *' divine ether," 
it was given for nearly fifteen minutes longer. The 
operation was happily concluded. The man continued 
very gay for a couple of hours, experienced no bad 
effects, and recovered rapidly. 

The second case was one of ununited fracture of the 
radius, treated by a seton. This patient had broken 
his fore-arm about six months previously ; the ulna was 
consolidated, the radius remaining ununited. What 
produced this result was not ascertained. As the man 
was perfectly healthy, it could not be attributed to a 
constitutional difficulty, but the probable cause was his 
movements of the hand in rotation during the treat- 
ment. 



48 



Tlie arm was left for some time without any applica- 
tion, except stimulating frictions adapted to restore a 
kealthy condition, and then a seton was introduced. 
The direction of the fracture was such, that the passage 
of the needle across from without inwards would cause 
it to impinge on the ulna. In order to avoid this diffi- 
culty, a dissection was made on the anterior face of the 
radius. The needle could not, however, so close was 
their junction, be forced between the extremities of the 
fragments. It therefore became necessary to divide 
some of the adhesions with a knife, and to open a pas- 
sage by a small chisel, aiding this process by such a 
posture of the arm as seemed most to favor it ; then the 
needle, being passed from without inwards, and from 
before backwards, was made to issue behind the ulna. 
From ten to fifteen minutes were required ; etherization 
by the sponge was continued through the whole opera- 
tion, and the patient awoke after its removal, in a happy 
state. 

Inflammation succeeded, with symptoms so violent, 
that the seton was withdrawn in ten days — a period 
too short, as was afterwards found, for perfect success ; 
the motion, though diminished, being perceptible at the 
end of seven weeks. After this time, it rather in- 
creased than diminished, and another operation was 
required. The patient was etherized as before ; an in- 
cision, about two inches long, made on the outer edge 
of the fracture ; and at a right angle with this, another 
incision, an inch long, over the back of the radius. 
The fractured extremities being well exposed, their 
ligamentary adhesion was divided by a knife, and a 



49 



peg of ivory, two inches long, passed between them. 
Then, in conformity with the advice of DiefFenbach, a 
hole was bored in the extremities of the upper and 
lower fragments, and a peg inserted in each. The 
patient was quite awake through the process, and talked 
humorously, but did not acknowledge pain ; thus pre-- 
senting distinctly one of the instances of the existence 
of the intellectual faculties with the absence of the 
sensitive ; and affording, of course, a distinct objection 
to the hypothesis of Mons. Longet, which maintains 
that the cerebral lobes are always etherized before the 
sensitive ganglia. 

In the preceding case, slight variation in posture 
favored the passage of instruments, which without it 
could not be made to penetrate. I noticed the same 
fact in two such operations on the os humeri, performed 
during the last year with a successful result ; one of 
them on an attendant of the Hospital, the other on a 
female about forty years old, in whom the brachial 
artery, interfering with the passage of the needle, re- 
quired a dissection to remove the vessel from its course. 
It may be useful to remark, that in the last case, as 
well as some others, I have seen the want of union to 
be the result of an application of splints and bandages 
so close and long continued, as to check the action of 
the blood vessels and nerves. 

Sir Benjamin Brodie, in one of the valuable practical 
papers with which he so often favors the public, speaks 
of a number of cases of ununited fracture attributable 
to general debility. Such cases I have also seen ; but 
those which have occurred within the last two or three 
6 



50 



years have arisen principally from local weakness, 
caused, as I have said, by too great pressure from 
splints and bandages. 

The third of these cases was that of a young Portu- 
guese seaman, who had a fracture of the leg at sea, about 
a year before. On the outer side of the leg, in the 
situation of the upper part of the fibula, appeared a 
considerable projection, such as might be formed by an 
extraordinary effusion of osseous, cartilaginous and fi* 
brous substance. The patient could not use his limb, 
but his most urgent reason for asking aid was, that he 
experienced incessant pain in the enlarged part. Many 
applications were made without mitigating his sufferings. 

Having been requested by Dr. Townsend, whose 
patient he was, to examine the limb, I suggested the 
expediency of cutting down to the bone, in order to 
ascertain what the nature of the difficulty was, whether 
the peroneal nerve might be compressed by the bony 
matter, whether there might be a collection of fluid, an 
aneurismal formation, or other disease of the bone. To 
this proposition Dr. T. kindly consented, and I made 
an incision four inches long on the outside of the fibula, 
along the surface of the tumour, and on a line from the 
head of the fibula downwards towards the malleolus. 
The peroneal muscles were separated, dissected from 
the surface of the tumour, and with them a large branch 
of the peroneal nerve lying in contact with the bone. 
The parts were held aside, in order to expose the tu- 
mour more fully — a process which would certainly 
have been very painful, if the patient had possessed 
his sense of feeling at the time. 



51 



The bone was then penetrated by a perforator, to the 
depth of an inch. The perforation being enlarged, so 
as to admit the little finger, disclosed a cavity, two or 
three inches in length, lined by cellular parietes, con- 
stituting the disease known by the name of spina ven- 
tosa, or osseous sero-cystic tumour. As there was no 
sign of malignity, the proceeding which seemed best, 
was to remove the externo-lateral wall of the bony 
tumour, in the hope of relieving the pain produced by 
its pressure on the surrounding parts ; leaving the ques- 
tion of amputation, and that of excision of the whole 
bony tumour, to be decided by subsequent events. 

The operative process, including some intermissions 
for consideration, lasted nearly thirty minutes. The 
patient was perfectly insensible through the whole, in 
consequence of the continuous application of the sponge. 
He awoke in a pleasant state of mind, and had no bad 
effects from the ether. 

After the wound had healed, pain recurred, and the 
tumour regularly enlarged. The peroneal branch of 
nerve on its surface became inflamed, so that the slight- 
est pressure on it was insupportable, and the outside of 
the foot and leg occasionally lost their sensibility. It 
now seemed necessary to remove the diseased bone ; but 
this could not be done without the destruction of the 
peroneal nerve and artery, and also, the interosseous 
space being occupied by the tumour, of the anterior 
tibial artery and nerve. The consequence of these 
lesions would have been paralysis of a good part of the 
limb, and probably a gangrene which would involve 
the whole, and perhaps prove flital. 



52 



It was determined, therefore, to amputate the tibia 
at the place of election, and excise the whole fibula. 
This was accomplished, a good flap procured from the 
posterior part of the limb, and the patient is now re- 
covering. 

The diseased part of the bone was found to be six 
inches long; its circumference was nine inches. It 
contained a single cavity filled with yellow serum, which 
on opening the tumour was projected between two and 
tlu'ee feet — thus showing it had exerted on the bony 
cavity and its membranous Iming a strong pressure. 
The aperture made in the first operation had been 
closed by a fibrous membrane. 

This patient required at least twenty minutes for 
etherization. At the end of this time, he was insen- 
sible, and experienced no bad symptom from ether 
afterwards. 

Strangulated Hernia. — One of the earliest thoughts 
that occurred after the introduction of ethereal inhala- 
tion, was its applicability to strangulation of the viscera. 
In various amputations, we noticed a loss of contractile 
power in the muscles while etherization continued ; and 
this observation was confirmed by a number of other 
etherized cases, in which the muscular contraction first 
occurring was succeeded by remarkable relaxation. 
Hernial strictures caused by, or connected with, a state 
of muscular contraction, might be expected to relax 
under the same influence, and allow the return of pro- 
truded organs. The use of tobacco, the warm bath, 
and copious bleeding, have been employed with this 
intention. Even the organic muscles may be affected 



53 



by such influences ; and hence, no doubt, arose the 
suggestion made by Nysten, of the usefulness of ether 
in colic — a suggestion made in the history of the first 
six cases of etherization, without a knowledge of its 
mention by Nysten. 

Two cases only of strangulated hernia treated by 
ether have come within our experience, one of which 
we shall mention. 

In the month of June, 1847, Dr. J. M. Warren was 
called in consultation to a female patient, laboring for 
eight days under strangulated crural hernia. She had 
foecal vomiting, great tension of the abdominal muscles, 
with much pain and tenderness in the tumour. Taxis 
having been unavailingly attempted, she was placed 
under ether, preparatory to an operation. The abdom- 
inal muscles previously tense were entirely relaxed, 
pressure on the tumour was made without pain, and the 
hernia readily reduced. 

Notwithstanding the long period of strangulation, she 
recovered — -a fact which would be more surprising, 
had we not frequently noticed it in strangulated crural 
hernia. In looking for a cause of this occurrence, we 
have been led to impute it to the comparatively small 
volume of this species of hernia. 

My friend, Dr. Hosack, of New York, has given an 
account of a strangulated hernia reduced by ether, in 
the Boston Medical and Surgical Journal, of August 
11, 1847.* 

^ A fact occurred at the time of writing: these lines, wliich 
may be worth mentioning. Dr. Wales, of Jamaica Phiins, 
brought to me a little Irish infant, three months old, with a 

6 * 



54 



Feigned Diseases — Ether has been employed sue- 
cessfuUy to detect the imposture of feigned diseases. 
In Europe it is not uncommon among the poorer classes 
to find individuals who, in order to excite compassion, 
obtain charity, procure admission to a hospital, or avoid 
some unpleasant requisition, feign contractions of the 
limbs, deafness, inability to speak, etc. Etherization 
overpowering the will which maintains these appear- 
ances, the contracted muscles relax, the deaf man hears, 
and the dumb speaks. Although such impositions are 
comparatively rare in this country, we have occasionally 
seen them, and had opportunity of observing the tem- 
porary restoration of limbs affected with distortions, 
which before seemed permanent. 

Tetanus. — Etherization may be employed for the 
relief of tetanic spasm ; but while it mitigates the dis- 
tress of the muscular contractions, it cannot be expected 
to overcome the inflammatory action of the spinal mem- 
branes, or the medulla they envelope. 

Neuralgia. — The paroxysms of neuralgia may be 
relieved by ethereal inhalation, and great comfort ob- 
tained by the interruption of long fits of this affection. 
Sometimes the paroxysm is quite broken up ; but I 
have seen no instance of a final cure. Such, however, 



large coBgenital strangulated inguinal hernia, of two days' du- 
ration. After examining the tumour, I was about to etherize 
the child, when it fainted, and appeared to be in a dying state. 
The proposed etherization was suspended, and while awaiting 
the event, we heard a movement of the bowels ; the hernia re- 
treated, an evacuation followed, the patient revived, and did 
well. In this instance, the state of faintness produced a mus- 
cular relaxation, which removed the impediment to the return 
of the viscera. 



55 



I have strong hopes, may hereafter occur, as the result 
of a patient and repeated use of this practice. 

STfiiCTURES. — Spasmodic or inflammatory contrac- 
tions in muscular tubes destined for the admission of 
alimentary substances, or for the expulsion of excre- 
mentitious matters, constitute a class of affections often 
very difficult to overcome. Organic strictures, or those 
which result from an adventitious deposit of healthy or 
morbid particles, would scarcely seem to come within 
the limits of ethereal practice — yet I have seen even 
in these cases good effects from its influence. 

In the latter part of July, 1847, a gentleman ap- 
plied for a difficulty in swallowing, as he called it. 
His food, he said, passed down to a certain point, and 
after being retained there for a while, was rejected. 
Suspecting he had a stricture of the oesophagus, I 
attempted to introduce the balled probang, but found 
it impossible ; the sponge was then put to his nostrils. 
In two minutes, the patient repeatedly spoken to did 
not reply. The instrument was now passed down as 
far as the stricture without excitement or movement, 
carried through it, and moved up and down three or 
four times. The movements through the stricture ex- 
cited oesophageal and gastric contractions by reflex ac- 
tion, without awakening intellect. After the removal 
of the instrument, the patient being spoken to, awoke, 
and said that he had no knowledge of its introduction. 
Graduated globes and pyramidal wedges were employed 
many times afterwards ; and when, as often happened, 
the stricture resisted the passage of the instrument, it 
was overcome by etherization. The patient was re- 



56 



lieved, and returned home, with instructiojis for a con- 
tinuance of the process. 

Stricture of the urethra, producing retention of urine, 
is a very fair subject for the practice. When this re- 
tention has continued long, a great accumulation of 
urine taken place, accompanied with much suffering, 
after a succession of ineffectual efforts, the surgeon is, 
by a natural impulse, tempted to a forcible use of in- 
struments, and the frequent consequence is a disorgan- 
ization of the urethra, from which it never recovers. 
Experience has taught, that when moderate and judi- 
cious trials of bougies and catheters do not succeed, 
these instruments should be laid aside, and the patient 
left to the action of those remedies which subdue in- 
flammation and produce relaxation. Leeches, the 
warm (sometimes the cold) bath, and narcotics, will 
often succeed, with the help of nature, where instru- 
ments have failed. Etherization is here a happy aux- 
iliary, as may be illustrated by the following case. 

Dr. J. M. Warren was called in consultation to a 
gentleman, who had suffered from a retention by stric- 
ture for ten or twelve hours. It not being possible to 
pass an instrument without violence, leeches, the warm 
bath, opium, etc. had been ineffectually used. Great 
distension of the bladder having taken place, attended 
with extreme suffering, it was agreed to etherize the 
patient before any further efforts were made. As soon 
as etherization was accomplished, a few drops of water 
began to trickle away, and the instrument was passed 
without difficulty. The passage being open, no further 
obstruction occurred, and he recovered in a few days. 



5T 



The following case also illustrates the power of ether- 
ization in causing relaxation of the urinary passages. 
In the month of October, 1847, a man was brought 
into the Massachusetts Greneral Hospital with an infil- 
tration of urine. The bladder had ruptured apparently 
in the perinaeum, and the urine had infiltrated the scro- 
tum and abdominal parietes to a great extent. 

The state of the bladder was explored on the surface 
of the abdomen and in the rectum. The abdomen was 
extremely distended, but on its right inferior side was 
found to be soft, and this fact led to the inference, that 
the abdominal hardness was not caused by distention of 
the bladder. This point being settled, I next proceeded 
to examine the state of the urethra, and as the patient 
was very sensitive, and in great pain, he was etherized. 
Instruments passed into the canal were, as I expected, 
interrupted, none could be made to approach the blad- 
der, but immediately after etherization there was a dis- 
charge of urine by the urethra. On examination by 
the rectum the bladder was not discovered, but a col- 
lection of knotted tumours was found behind the usual 
situation of the prostate gland. There was then no 
distention of the bladder, and of course no occasion for 
its puncture. 

The most important thing to be done under existing 
circumstances, was to relieve the infiltration as much as 
possible, by giving vent to the urine in the cellular 
texture. I therefore made an incision in the most de- 
pendent part of the scrotum, on each side of the raphe, 
and full two inches long. The patient was ordered 
into the warm bath, had warm injections into the rectum, 



58 



and etherization once in six hours. On each etherization 
there was some discharge of urine from the urethra. 

On the day following, however, the symptoms were 
aggravated, there was great distress, great prostration, 
the scrotum black, the abdominal swelling increased, 
extended over the left flank to the spine, and covered 
by an erythematous eruption. The man's case seemed 
to be nearly desperate. I determined then to make a 
large incision through the abdominal swelling, and to 
penetrate the tumour wherever it was. 

The patient being again etherized, an incision three 
inches long on the prominent part of the tumour, fol- 
lowed by a careful dissection, at length produced a 
small jet of urine. The aperture being widened by a 
probe, was then freely dilated, and a copious urinary 
discharge, accompanied with flocculent lymph, followed. 
The bed was inundated. The finger passed through 
the aperture, discovered a large cavity extended over 
the left portion of the abdominal parietes, and towards 
the scrotum. It now only remained to procure a de- 
pendent opening for the urinary fluid. In order to 
accomplish this, a lithotomy-staff was passed through 
the abdominal incision into the left scrotum, then insin- 
uated from within the scrotum outwards through the 
scrotal incision made the day previous. On the staiT 
the cellular texture of the scrotum was divided the 
length of the external incision. By means of this, a 
free drainage of all the stagnant urine was obtained ; — 
the symptoms were immediately alleviated. On the 
day following, there was no suffering ; he took nourish- 
ment, and appeared convalescent. 



59 



This patient seemed to be doing well for the six days 
following. On the seventh, he began to fail, and on 
the eighth died, without any new symptoms which could 
account for his death. On examination, the vesiculae 
seminales, vasa deferentia, and ureters were found to 
be indurated — the latter were enlarged through their 
whole extent. One of the kidnies presented various 
cavities, produced, no doubt, by revulsion of urine from 
the bladder. This organ was very much contracted, its 
mucous coat ulcerated, and in one or two points this 
coat formed hernia, from the powerful contractions of 
the bladder on its contents. The rupture of the urethra 
was a little in front of the bulb, and about half an inch 
in length. Before the rupture appeared its cause, a 
membranous prolongation stretched obliquely across the 
urethra. 

In this case, ether operated favorably in two ways ; 
first, by occasionally producing a small flow of urine ; 
and second, by the absolute rest it induced during the 
second operation, in consequence of which, a dangerous 
and uncertain dissection could be made with perfect 
tranquility. 

Lithotomy. — This is an operation whose terrors may 
be greatly diminished by ether. The exquisite sujffer- 
ing, the spasmodic constriction of wounded muscles, the 
irregular pouch-like contractions of the muscular coat 
'of the bladder, under its use, must cease to act as ob- 
stacles, and their cessation give an ease and freedom of 
mind to the surgeon, which might enable him to en- 
•counter other dangers with confidence that he can sub- 
due them. The stone in the bladder, as I have had 



60 



occasion to notice, is so exceedingly rare in this region, 
that during forty-five years I have not encountered as 
many instances, inckiding together cases of lithotomy, 
lithotrity, and those not subjected to any surgical ope- 
ration. And since the introduction of etherization, I 
have not had occasion to perform the cutting operation. 
For, although called on to do so, I have been able to 
avoid its dangers by the operation of lithotrity with 
happy results. This, however, brings its peculiar dif- 
ficulties and dangers ; the latter never in my practice 
amounting to any thing formidable, but the former 
much exceeding in extent those of lithotomy. The 
irritable state of the urethra, the great sensibility of the 
bladder, the partial and general contractions of the 
vesical muscles, the lodgement of broken fragments in 
the urethra, the tedious repetitions sometimes required 
concur to embarrass the surgeon, and render his ap- 
proach to this process less agreeable than to the more 
dangerous one of lithotomy. 

Among the occurrences of lithotrity, the most trou- 
blesome of those already named is a partial contraction 
of the bladder. When the operation has been fre- 
quently repeated, I have had occasion to notice, that 
the stone-breaker, after seeming to enter the cavity, 
and after having actually entered the prostatic portion, 
could not be brought into contact with the stone ; and on 
passing the finger into the rectum, it has been found 
that the instrument was arrested immediately beyond 
the prostate, by impinging against the vesical tunics, 
crowded down towards the urethral aperture by a con- 
traction apparently resembling the hour-glass contrac- 



61 



tion of the uterus. By the aid of a finger in the rec- 
tum, the instrument may be conducted in such cases 
into the superior region, and the stone thus attained. 
Those expert in lithotrity may perhaps believe, that 
this difficulty might be obviated by a sufficient disten- 
tion with water ; but they will recollect, that this dis- 
tention, even though moderate, produces a painful dis- 
position to expel the liquid, and that it often is expelled 
in a very short time, especially in females. So often 
has this occurred, that I have been led to apprehend, 
that the stone may generally be seized with as great 
facility, and as little danger of including the vesical 
coats without, as with, this preparatory step. Dr. Ran- 
dolph, the most able lithotritist of this country, has, I 
think, the same opinion. Etherization is especially 
adapted to obviate the accident alluded to. 

A gentleman applied to me to perform the operation 
of lithotomy on himself. He had been examined, and 
a stone found ; but the consequences of this examina- 
tion, although it had been carefully conducted, led him 
to the conclusion, that he could never submit to the 
irritating repetitions of lithotrity. After a fall con- 
versation with him, he agreed to undergo another ex- 
amination under the influence of ether; and so far 
from suffering while it was made, he described his sen- 
sations to be altogether pleasurable. No irritation fol- 
lowed, and shortly after he underwent lithotrity. The 
stone, about the size of an almond, was crushed, 
and the greater part of it removed by a single opera- 
tion : a second completed its demolition. The whole 
process was without pain ; and the patient speedily, and 
7 



62 



to himself unexpectedly, was restored to health and 
usefulness. 

The following case will further illustrate the use of 
ether in favoring the exploration of the urinary bladder, 
when a stone is suspected to exist. Dr. J. M. Warren 
was requested by Dr. Morrill to see a little boy, four 
years old, who had symptoms of stone. The child was 
utterly intractable, until by the application of ether he 
was put to sleep, and then an examination being made, 
resulted in the discovery of a stone in the bladder. 

As this disease scarcely ever occurs here, it was a 
matter of interest to ascertain, whether any accidental 
cause might have given origin to it. The only known 
occurrence, to which the concretion could be attributed, 
was the following. The child was passing his water in 
the street, and, while doing so, was thrown down by 
another boy, and dragged over some gravel. On the 
following day he complained so much, that his mother 
examined, and found a gravel stone in the urethra, 
which she removed. In four months afterwards, he 
began to exhibit symptoms of stone, which have con- 
tinued to increase in violence for about two years and 
a half. 

The symptoms became so distressing and so strongly 
indicative of stone, that it was thought necessary to 
make an examination. Such was the pain, that violent 
contractions of the bladder took place, accompanied 
with protrusion of the rectum, so that no examination 
could be accomplished until ether was employed, when 
a sound was introduced, and a gritty substance dis- 
covered. The examination did not, however, give full 



63 



evidence of the nature of the affection, and required 
repetition at three different times. In each instance, 
etherization was employed in the most satisfactory 
manner. 

On November 16th I saw the boy with Dr. Mason 
Warren and other gentlemen ; we all became satisfied 
of the existence of a very small stone in the bladder. 
The smallest lithotrity-instruments would not pass the 
urethra. The operation of lithotomy was therefore im- 
mediately performed by Dr. Mason Warren by the 
crescentic or bi-lateral mode, and the stone removed. 
Ether was invaluable during the examination and ope- 
ration.* 

In this connection may be noticed operations for 
vesico-vaginal fistula, generally very painful and very 
unsuccessful. These operations have been performed 
by Drs. Hay ward and J. M. Warren, with perfect free- 
dom from suffering, and hence greater facility afforded 
in bringing the parts into view, and allowing of their 
more perfect adjustment. 

Operations on the Eectum. — Painless applications 
of ligature in haemorrhoidal and prolapsed excrescences 
of the rectum, operations for fistula in ano, and other 
diseases of these parts, might be mentioned ; but not 
presenting any thing remarkable, we shall pass them 
over. 

Cautery. — The actual cautery is viewed with so 
much dread in this country, and I believe also in Great 
Britain, that we rarely have been able to avail oui'sclves 

"^ See Appendix C. 



64 



of its great benefits. Lately having the power to give 
the assurance, that it might be employed without the 
usual pain, a consent has been obtained, which^ although 
at first reluctant and skeptical, has, by many successful 
tiials, now changed to a ready and perfect confidence. 

In the month of May, 1847, there being an annual 
meeting in Boston of the State Medical Society, occa- 
sion was taken to invite the members to witness some 
operations about to be performed in the hospital. 

After two operations with etherization, which suc- 
ceeded perfectly, a delicate female, laboring under a 
disease of the spinal marrow with general neuralgia, 
was subjected to the actual cautery. A space on each 
side of the dorso-lumbar region of the spine was cau- 
terised by red-hot irons, one of which was an inch 
square, passed up and down slowly three times on each 
side without the slightest suffering.* All were struck 
with admiration at this result, and none more than my- 
self, although I had witnessed it before. In truth it 
may be said, the change of nervous susceptibility by 
etherization is so very remarkable, that, after all the 
cases we have witnessed, every new operation with 
ether excites fresh wonder, and leads one almost to 
doubt the evidence of his senses. 

Dysmenorrhcea. — The pains of dysmenoiThoea, 
though temporarily relieved by the use of opium, are 
very distressing to many individuals. The practice 
of the late ingenious Dr. Mackintosh, of Edinburgh, 

"^ When tlie iron is heated to whiteness, pain is known to be 
less than when it is only red-hot; but, as ether was to be em- 
ployed, this condition was not thought necessary. 



65 



promised for a time to afford the desired relief ; but 
the hopes it excited have now in a great measure died 
away, and although it is used with various modifications 
by some practitioners in Europe, and has been partially 
adopted in this country, the general sense of the pro- 
fession, so far as I can judge, is not favorable to it. 
It may be doubted, also, whether the anatomical fact, 
on which his practice was founded, is generally true. 
He exhibited to the author a number of specimens 
taken from patients affected with dysmenorrhoea, in 
which existed a very contracted state of the os uteri, 
and to this state he attributed the difficult passage of 
the uterine excretion. In some very severe instances 
of this derangement the aperture has been found to be 
quite as large as in healthy persons. 

When a new remedy is brought forward with some 
little success, our profession naturally fly to it, and 
employ it with perhaps too little discrimination in a 
variety of affections. It soon wears out, and is either 
wholly abandoned, or used to a very limited extent. 

Dysmenorrhoea, intractable as it has been under 
medical treatment, and breaking down as it does the 
constitutions of many young persons, is a pretty fair 
subject for judicious experiments, and may perhaps be 
considered as not exposed to the objection alluded to. 
As etherization relieves other pains, why may it not 
relieve the pains of dysmenorrhoea ? It may be ex- 
pected to do so temporarily at least, and with less ill 
consequence than opium and most of the narcotics. 
The results in those cases, in which I have thought 
proper to recommend it, have not, for the want of time, 
7 * 



66 



been sufficiently numerous to justify any general state- 
ment in regard to its utility. They have been, how- 
ever, so far satisfactory, as to lead to its trial in all 
severe cases. 

An English gentleman,, resident in this place, came 
to me a few months since for information on this sub- 
ject. He said,^ that his wife had from her youth been 
afflicted with atrocious pains at the monthly period. 
During its continuance, she suffered so violently, as 
sometimes to produce convulsions. He had, while in 
England, naturally consulted the most able and ex- 
perienced practitioners ; but as yet nothing had been 
found to be permanently beneficial, except opium. 

Soon after, I had an opportunity of seeing her in one 
of the paroxysms, and suggested such means as seemed 
likely to give relief. At the next periodical occur- 
rence, the symptoms being of an alarming character, 
etherization was employed, the distress was at once re- 
lieved, and the paroxysm broken. 

Some months after the first application, this patient 
had another severe and alarming paroxysm of her com- 
plaint. Opium and other remedies were employed 
without important relief. Ultimately, etherization was 
resorted to, with the effect to mitigate the pains, which, 
however, recurred from time to time, until a pint of 
ether had been consumed. The paroxysm did not ter- 
minate, until there was an expulsion of a membranous 
formation, similar to that described by Dr. Oldham in 
the London Medical Gazette of April 16, 1846. 

Midwifery. — The application of ether for the alle- 
viation of the pangs of labour may seem to claim atten- 



67 



tion. The reversal of the decree of nature, which in 
human kind connects suffering with parturition^ would 
indeed be a phenomenon as remarkable as any medical 
science has revealed. There is no parity between the 
abolition of pain in surgical operations, and the aboli- 
tion of the pains of labour. The former is only a part 
of that action of a general law for preservation against 
injury, in consequence of which, whenever a foreign 
body threatens to impair the integrity of an organ, pain 
is produced, and the organ is instinctively withdrawn 
from the contact. Hence each organ has its sensitive- 
ness peculiarly adapted to its own protection : — the 
eye is irritated by an atom which would produce no 
impression on the skin ; the skin is exquisitely affected 
by the cut of an instrument which would cause little 
pain in a ligament; while the ligament, unconscious 
almost of the presence of a knife, is severely pained by 
those distortions which might lacerate. Nature has 
thus given to each part a sensibility which warns it of 
external danger; and by this warning she affords, to a 
certain extent, the means of escape. A kind provision 
also for the relief of internal pain and disease is boun- 
tifally provided in the copious stores of the Materia 
Medica. 

There is therefore nothing contrary to the laws of 
nature in the removal of pain from surgical operations. 
Some, indeed, have said, that such pain is, as a final 
cause, necessary to warn the surgeon of his approach 
to textures, or organs, it would be dangerous to touch ; 
but this opinion will, perhaps, not bear very close ex- 
amination. The outer coat of a great artery, for exam- 



68 



pie, apart from the accompanying nerves^ is not very 
sensitive ; nor are the pleura, the peritoneum, tunica 
arachnoidea, dura mater, — all of them oro:ans not to 
be wounded without danger. Some nerves, whose in- 
tegrity is essential to life, possess a sensitiveness less 
than those distributed to parts comparatively unim- 
portant. Dissection of the par vagum from the coat 
of a tumour is accomplished with less pain, than that 
of one of the cervieo-spinal nerves. The proper guide 
to the surgeon is not the variable sensitiveness of the 
organs he is dealing with, but his knowledge of their 
situation and relation. Suffering, then, is no essential 
or useful part of a surgical operation. 

The law which regulates the pains of labour is a 
general law, which cannot be changed by the power 
of science. Its final cause is sufficiently plain to show 
its utility and necessity. Like most general laws, this, 
however, may have its exceptions, and we may increase 
the number of these exceptions by the aid of art. 

Besides the objections to the universal application of 
ether on the gTOunds exposed above, there are others 
of a specific character, which can hardly fail to occur 
in this department of practice. The use of so powerful 
an application through the whole period of a natural 
labour would, in proportion to the term of that labour, 
increase the dangerous tendency to organic excitation ; 
and when this period is very protracted, it might bring 
on distressing derangements of the stomach, brain, 
spinal marrow, or uterus. Another objection to its 
free employment is, that it does, in many cases, sus- 
pend the uterine contractions. 



69 



The cases, then, in which ether could be properly 
resorted to, should be considered as exceptions, and we 
will specify the following : 1st, in a natural labour, 
when the pains are uncommonly severe, especially the 
terminating pains in a first parturition ; 2d, during 
limited periods of labours prolonged by a preternatural 
cause ; 3d, when, from the peculiarity of constitution, 
the patient cannot, without danger, support the usual 
amount of suffering ; 4th, for the purpose of obtaining 
relaxation in irregular contractions of the uterus, such, 
for example, as the hour-glass contraction after delivery. 

These suggestions are founded principally on a gen- 
eral knowledge of the effects of ethereal inhalation, and 
not on the results of my own personal experience. My 
son has, however, employed etherization in obstetrical 
practice with results which appear to me in the light 
of exceptions to the general law. 

Among other instances, the following may be men- 
tioned. A lady was ill eighty-four hours, during forty 
of which she was more or less etherized with great re- 
lief, and passed through the terminating pains without 
any symptom of suffering, or any recollection of them. 
I had an opportunity of seeing this lady after her con- 
finement repeatedly ; found her in an excellent state, 
and without any unpleasant consequence. Those who 
wish for particular information in regard to this practice, 
may consult the publications of Dr. Channing, of Boston, 
Dr. Simpson, of Edinburgh, and Professor Dubois, of 
Paris. 

Death. — A very important use of etherism remains 
to be noticed. In a former pai*t of these pages, its ap- 



70 



plication for the relief of the last distressing state of 
pulmonic inflammation has been transiently adverted 
to. Since the establishment of ethereal practice in 
surgical operations, its former utility in mitigating the 
agonies of death has led me to employ its influence in 
a more free and decided manner. And so far as the 
trials have extended, they serve to justify its use in a 
great number, and I hope I may say without enthu- 
siasm, in the majority of instances. Should this prove, 
on a full trial, to be the fact, the value of the discovery 
will be greatly enhanced, since the number of those 
who are called on to suffer in the struggle between life 
and death, is greater than that of those who are com- 
pelled to submit to the pain of surgical operations. 

I am fully aware, that the agony in the dissolution 
of the bond between the bodily frame and its spiritual 
tenant, is not so great as it is believed to be ; for, 
having questioned a great number of persons passing 
through the last stage of earthly existence, whether 
they suffered pain, the answer has been almost uni- 
formly in the negative ; and on inquiring what sensa- 
tion was experienced, the reply has been such as to 
lead me to consider it an undefinable sense of discom- 
fort. The intellectual faculties appear to be so clouded 
and confused, that they are unable to take cognizance 
of the agitation which convulses the physical organ- 
ization. 

There are, however, exceptional cases, in which there 
is great bodily suflfering ; and there is in all men an 
instinctive dread of the pains of death. If we find 
the means of preventing or relieving these pains, tho 



71 



great change may be viewed without horror, and even 
with tranquillity. He who would experience a real 
euthanasia should not, however, trust merely to the 
virtues of ether, but should also have settled his ac- 
counts with this world, and be well prepared to settle 
those of the future. 

In illustration of the practice alluded to, may be 
mentioned the case of a lady^ who died of dysentery 
in the summer of 1847, at the age of ninety. She 
had been my patient more than forty years ; and during 
that time, besides heavy domestic calamities, had un- 
dergone a number of attacks of pleurisy, one of peri- 
carditis, a severe and protracted bleeding from the 
stomach, with symptoms of malignant disease of this 
organ. She was once dangerously poisoned by eating 
partridge ; moreover, by a fall she had a fracture of the 
neck of the thigh-bone, and soon after her restoration, 
was attacked with senile mortification of the foot, from 
which, having suffered months of intense pain, she 
wholly recovered. 

Very temperate in her eating and drinking, and of a 
religious character, she was cheerful, notwithstanding 
all these visitations ; appeared to enjoy life more as she 
grew older^ went out freely, and made two or three 
excursions into the country within a few weeks of her 
last illness. 

The dysenteric attack, which terminated her career, 
accompanied with symptoms of unusual severity, was 
only relieved for a very short time by the use of 
opium. After more than two weeks of illness, violent 
pain occurred in one of the feet, with discoloration, 



72 



ending in gangrene. The pain of mortification S'lJ- 
denly ceasing under the use of opium, that of the 
abdomen returned, with convulsive twitchings of the 
limbs; and other remedies failing to mitigate these 
symptoms, inhalation of ether was employed with per- 
fect relief. 

From the first inhalation to the period of her death, 
five days elapsed, during which a considerable number 
of etherizations were used, and with such effect, that, 
as soon as any suffering occurred, she desired ether. 
In the intervals, her mind was clear, she arranged such 
worldly matters as remained unsettled, received the 
consolations of religion, and finally under ethereal in- 
fluence her spirit imperceptibly took its flight. 

Vivisections. — An excellent use of ether may be 
made in regard to animal vivisections. The people of 
this country, in common with their English progenitors, 
have always viewed the torturing of living animals for 
scientific purposes, with invincible repugnance. Great 
has been the sacrifice of improvement in physiology and 
surgery, which this sentiment has cost the medical pro- 
fession. Ether enables us to lull the sensibilities of the 
victim, tranquilly pursue the natural workings of the 
internal organs, and the changes which take place from 
experimental applications ; while the student of surgery 
can accustom himself to those gushes of the vital fluid, 
.which, in the human body, are viewed with so much 
terror by the unpractised. 

Animals of any size may be etherized in a box, or 
by covering the head with an India-rubber sack, into 
which a mixture of ether and atmospheric air is forced. 



73 



Dr. B. Brown, of this city, in the spring of 1847, 
was the first in this country, so far as I know, to em- 
ploy etherization for the prevention of pain in surgical 
operations on animals. Latterly, others have satisfact- 
orily adopted the same practice. 

General Conclusions. — The views we have taken 
on this subject, suggest the following inferences : 

1st. Inhalation of ether produces insensibility to 
pain. 

2d. Ethereal insensibility, judiciously effected, is not 
followed by any dangerous consequences. 

3d. Its administration is easy, and usually requires 
but a few minutes. 

4th. Individuals of all ages may be safely etherized. 

5th. Individuals of the same age are susceptible of 
the influence of ether in variable degrees. 

6th. Surgical operations may be done under the effect 
of ether, which could not be done without. 

7th. Operations very short, and not very painful, 
especially those about the head and neck, are best done 
without ether. 

8th. The shock of the nervous system is greatly di- 
minished by etherization. 

9th. The use of ether has increased the number of 
successful operations, by encouraging a resort to them 
at an earlier period of disease. 

10th. The use of the sponge is more safe and easy 
than that of any special apparatus. 

11th. A special apparatus is convenient for some 
peculiar cases. 



74 



12th. The existence of chronic puhnonary disease 
rarely forms an objection to etherization. 

13th. Etherization may often be employed advan- 
tageously as a substitute for narcotics. 

14th. The employment of ether does not retard the 
healing of wounds, nor give them an unfavorable char- 
acter. 

15th. The pains of death may often be relieved by 
etherization. 



YI. 



For the most part the horizontal posture is favorable 
for etherization, because the patient is more easily com- 
posed. In the early practice, the tube and bottle being 
used, the patient almost constantly assumed the upright 
posture ; but we found reason to believe, that etheriza- 
tion was more speedily and perfectly accomplished in 
the horizontal, and therefore have made it a general 
rule to adopt the latter in preference to the former. In 
some operations, however, as for example in stricture of 
the oesophagus, this would be impracticable. 

The sponge will be found more convenient than any 
apparatus in the majority of instances, though we think 
that the mouth-tube may sometimes be proper. The 
sponge is preferable, because it requires less effort to 
inhale through it, and because the atmospheric air intro- 
duced with the ether removes the danger of asphyxia. 
Perhaps a longer time is required ; but this is a minor 
evil, and readily overcome by a little patience. 

The sponge should be of an excavated form, in order 
to accommodate the projection of the nose. The wind- 



76 



ing indirect channel of the nostrils, the more natural 
passage for the serial fluid, diminishes the impulse on 
the lungs, and the consequent propensity to a trouble- 
some cough. The sponge previously moist, saturated 
with ether of the purest quality [vide Appendix A], 
should be closely applied to the nasal apertures with 
due caution to prevent the introduction of the fluid into 
the mouth and eyes ; and its position should be occasion- 
ally changed, on account of the gravitation of the ether 
to its inferior part. Some patients prefer employing 
the sponge themselves, and this is true particularly in 
regard to parturient females. And so far as our ex- 
perience has extended, it has given us reason to believe, 
that the practice of committing the sponge to the patient 
may be advantageously adopted in a great number of 
instances. When the lungs are irritated, and cough 
produced, the sponge may be momentarily removed. 

The volatility and combustibility of ether should be 
kept in mind when it is employed by candle-light. 
Although there is no great reason to fear an explosion 
of the lungs, it is quite possible that the patient and the 
surgeon might be unpleasantly burnt by the careless 
approximation of flame. A patient of mine had been 
advised to apply a bandage dipped in ether for an affec- 
tion of one of his fingers, and having secured the ban- 
dage by a piece of thread, in the absence of a cutting 
instrument burnt off the string by the candle, in conse- 
quence of which he experienced something of a caut- 
erization. 

The quantity of ether employed has been thought to 
require exact measurement ; and, among others, the ce- 



77 



lebrated surgeon and author, Monsieur Bonnet, of Lyons, 
has invented an apparatus for accomplishing this pur- 
pose. The proper measure of quantity is its influence 
on the patient; and this influence must be obtained, 
whether it require drachms or ounces. As a matter of 
economy the measuring apparatus would be useful. 

It is to be taken into view, that the quantity of ether 
inhaled is gradually diminished by the reduction of 
temperature from its evaporation. The salivary excre- 
tion from the mouth is sometimes seen frozen on the 
sponge by cold from this evaporation. The ether in 
the sponge will of course become colder during the ap- 
plication ; its volatility, and therefore the quantity in- 
haled, consequently lessened. The addition to the 
sponge of fresh ether from time to time will sufficiently 
counteract this refrigeration. 

The quantity we have generally found necessary has 
been about two ounces ; yet, as already stated, we are 
not to be guided by the quantity of ether consumed, but 
by its eflfects on the patient. After careful inspection 
of two hundred cases of both sexes, of all ages, in a 
great variety of conditions of health and disease, ether- 
ized through a sponge without reference to quantity, we 
have seen no immediate or consequent symptoms, 
which would lead us to embarrass the patient and the 
surgeon with a complex apparatus. 

The time required is ordinarily from two to five min- 
utes ; but this may be prolonged in accordance with the 
length of the operation, and the difficulty of accom- 
plishing etherization. When this exceeds ten minutes, 
it is well to raise the sponge frequently, in order to ad- 



78 



mit a supply of pure atmosplieric air. Dr. J. M. War- 
ren noticed in obstetric cases, that the short panting 
inspirations natural to the latter stages produced a rapid 
etherization. 

In important operations there is an advantage in pre- 
liminary trials, to test the susceptibility of the patient, 
and instruct him in the manner of the application. 

The existence of etherization is usually recognised by 
the closure of the eyelids, if they had been previously 
open, by the non-respondence to questions, and by mus- 
cular relaxation. The pulse and respiration should be 
carefully observed, that, when they fail, the process may 
be discontinued, and the face of the patient sponged 
with cold water. Should this not be followed by a re- 
vival of the respiration and circulation, according to the 
advice of Dr. Jackson, oxygen gas may be thrown into 
the lungs. The stimulus of ammonia applied to the 
nostrils and throat, with frictions and hot applications 
over the body and extremities, may also be employed. 

Another remedy proposed for the state of insensibility 
is opium, introduced if possible into the stomach, and 
if not, into the rectum. In the latter case it should be 
used with the same quantity of water, and in rather a 
smaller dose than in the former; as dangerous narcotism, 
when least expected, sometimes follows injections into 
the rectum. I have known a gentleman dangerously 
narcotized by an injection of three drachms of the tinc- 
ture of opium, used in divided doses in the space of 
three hours. 

Children and infants may be safely etherized with 
proper precautions : the earliest period in my knowledge 



79 



has been within two or three months from birth. In 
very young infants, the state of the pulse, respiration, 
and of the senses, should be carefully watched. 

The administration to these young subjects, while it 
should be conducted with great attention, must be made 
in a decided manner. For when the sponge is applied 
to the nostril, the child attempts to retreat; but by con- 
tinuing its application a state of tranquillity soon follows, 
and a satisfactory etherization is accomplished. 

So far as my experience has extended, infants are 
not more speedily affected than adults, at least not more 
so in proportion to their tender age ; but, as I have al- 
ways proceeded with great caution in these young pa- 
tients, I may have been deceived on this point. 

For reasons already mentioned^ the injection of liquid 
ether into the rectum must be attended with great un- 
certainty; and the introduction of vaporized ether into 
the intestines, as it would operate on an absorbent sur- 
face less extended and less active than that of the lungs, 
could not be employed in ordinary cases with the same 
advantages as inhalation. There are, however, some 
conditions, in which it might be proper to throw into 
the rectum the ethereal vapor, as, for example ; first, 
when this could not be introduced into the lungs ; second, 
in cases when the inhalation had failed; third, when the 
intestines are the seat of a disease, which the vapor of 
ether might relieve. 

The injection of ethereal vapor into the rectum may 
be accomplished in the same manner as has been prac- 
tised for its injection into the Eustachian tube in cases 
of nervous deafness ; namely, by a glass tube having a 



80 



perforated bulb at one end, into wbicli the ether is to be 
poured, and the aperture stopped. The other end of 
the tube is to be connected with a caoutchouc tube 
passed into the rectum. By immersion of the bulb in 
warm water, the vaporised ether will be forced into the 
intestine. 

The subject of medicated ethereal inhalation is one 
of great importance. I have made some trials of this 
mode of introducing into the system articles of the 
Materia Medica with much satisfaction, but they are 
not as yet sufficiently numerous to justify me in recom- 
mending the practice. 



VII. 



Objections have been made to the use of ether 
in various disorders of the lungs. We have already 
mentioned instances of pulmonary affection, in which it 
was used with safety and advantage. When a patient 
has peculiar irritability of the lungs, it might be wise 
to avoid its use, unless it were imperiously called for. 
In common cases of tuberculous affections, whether in a 
crude or softened state, it is scarcely credible, that any 
permanent inconvenience could arise. 

In children and in infants, although the value of 
ether is great, in preventing suffering and facilitating 
indispensable operations, it should always be employed 
with great care, as previously mentioned, on account of 
the comparative difficulty of controlling its influence 
in the tender and excitable age. Ether has been found 
beneficial in the chronic cough of children, and is likely 
to be advantageous in hooping-cough, when the inflam- 
matory stage has passed. 

In acute pulmonary affections, in individuals predis- 
posed to cerebral excitements and congestions, and in 



82 



maniacs generally, the inhalation of ether should not be 
resorted to till we have had more experience. An in- 
stance of its use, however, in a deranged person came 
within our knowledge. 

Dr. Bell, of the McLean Asylum, wished to have 
an operation for epulis on a lady under his care ; and as 
he thought there would be no objection, she was ethe- 
rized. She was not very readily, nor powerfully affected. 
The tumour was cut from the gum, then the socket from 
which it sprang was included between three incisions of 
the bone-cutters, two vertical joined by a third horizon- 
tal. Some movements were made during the excision, 
but she afterwards said there was no suffering. No 
unusual mental disturbance followed, and in three days 
she was discharged. 

Every day is pregnant with new facts relating to this 
subject, and we have among others some of great im- 
portance bearing on the effect of etherization in cerebral 
diseases. The supposed dangers of etherization in these 
affections have been proved by observation to be wholly 
imaginary in some cases where they had seemed to be 
greatest. 

In the course of the present year, a French physician 
in Algiers ventured to employ etherization in cerebro- 
spinal meningitis. An epidemic of this character broke 
out in the French army of Algiers, from the effects of 
severe horse-exercise under exposure to the burning 
meridian sun of Africa. Bleeding, purging, cold ap- 
plications, and every other remedy suggested by the ima- 
gination, were employed to mitigate this disease, which, 
notwithstanding, often proved fatal in twenty-four hours* 



83 



Dr. Besseron, physician of the Military Hospital of 
Mustapha in Algiers (influenced perhaps by the opin- 
ion of the Italian physicians, that the effect of ether 
is hypo-sthenic or sedative), ventured with many pre- 
cautions to use etherization in this cerebral epidemic. 
He never carried it to the period of muscular excitation, 
employing not more than twenty-five inhalations at one 
application, and repeating it a number of times in 
twenty-four hours. After a few inhalations the patients 
experienced relief from the intense pain in the head and 
back, and at the close were quite free from pain. Out 
of twelve patients, eight were essentially relieved : two 
of them relapsed from adventitious circumstances, but 
six finally recovered their health — a result extremely 
remarkable compared with that from other modes of 
treatment. 

Monsieur Besseron does not hesitate to advise the 
trial of etherization in the meningitis of children. 

In delirum tremens it might be expected the practice 
would not be applicable ; but Dr. Stedman has used it 
in the Houses of Industry and Correction at South Bos- 
ton with good effect, and we have heard of other prac- 
tioners who have employed it advantageously in this 
affection. There may be other morbid conditions, in 
which experience will show that etherization is improper. 

In old persons the deficiency of reactive power, and 
consequent danger of extinguishing the vital principle, 
might excite apprehensions, although experience has 
not shown any ground for them hitherto. 

Cutting operations on the mouth and throat should 
not, I formerly thought, be performed with ether. But 



84 



a greater experience has led to the conclusion, that 
generally it may be used in these cases with safety and 
advantage. In excision of the tonsils particularly, the 
operation is so short, and the bleeding so slight, that 
there does not seem to be any objection, when the 
amygdalotome is employed. 



VIII. 



In the earlier part of these remarks, the circumstances 
attending the first use of ether in surgical operations 
have been sufficiently detailed, and their repetition here 
will be unnecessary. But there are some facts, relating 
to the previous history of ether, which we ought not to 
pass over. 

The medical public are by this time abundantly aware, 
that ethereal inhalation was proposed by Drs. Beddoes, 
Pearson, and Thornton, for the cure of some diseases of 
the lungs. Being in London about the period of their 
publications, I had an opportunity of becoming acquain- 
ted with the discussions which then took place on this 
subject. Its claims were subsequently advocated by 
Nysten and others. 

Sir Humphrey Davy himself successfully employed 
the inhalation of nitrous oxyde for the relief of pain. 
In this country, Dr. Horace Wells, of Connecticut, made 
many trials of this gas in 1844. In the autumn of 
that year he came to Boston, and, in company with Dr. 
Morton, visited me at the Medical College, for the pur- 
9 



86 



pose of requesting that the medical class should have an 
opportunity of hearing some remarks on the use of the 
nitrous oxyde for the prevention of pain. These re- 
marks were actually made, and at a subsequent day a 
trial of the gas took place. But, as I was very much 
occupied at the time, these occurrences made so little 
impression on my mind, that when, in the latter part of 
1846, we were assailed in reference to Dr. Morton's 
first experiments, for a too great facility in adopting 
novelties, and the facts above mentioned were brought 
to corroborate the charge, I was for some time not able 
to understand the grounds of the attack. Dr. Wells, 
however, in the summer of 1847, mentioned to me 
circumstances which recalled to my mind his visit; and 
his statement was afterwards confirmed by that of Dr. 
Morton. Such are the facts within my knowledge of 
Dr. Wells's efforts to discover a mode of preventing 
or alleviating pain in surgical operations. It appears 
that he did actually prosecute his trials in Connecticut, 
and elsewhere, to such an extent that, when the matter 
was investigated by the legislature of the State in the 
winter of 1847, his labors were thought worthy of hon- 
orable notice. 

Dr. Marcy, of New York, appears to have had com- 
munications with Dr. Wells on the inhalation of ether 
and of nitrous oxyde ; the result of which was, that 
he advised Dr. Wells to suspend the use of ether, and 
continue his trials with the nitrous oxyde. Whether 
these gentlemen had a knowledge of the proposal of Sir 
Humphrey Davy we are not able to say. 

Monsieur Ducos, in Paris, performed some remarka- 



87 



ble experiments with ether on animals early in the last 
year, an account of which is given in the Paris Medical 
Gazette, of March, 1846. In these experiments were 
exhibited most of the phenomena which have since 
been witnessed in the human body. The same inge- 
nious physiologist has recently succeeded in producing 
a state of insensibility to pain in animals by the use of 
electro-magnetism . 

This discovery certainly merits a notice from the 
American legislature, since it may take rank perhaps of 
all the great improvements which adorn the present age 
of surgery. The establishment of union by the first in- 
tention, the safe ligature of the great arteries, the sub- 
stitution of lithotrity for lithotomy, the rejection of 
pernicious ointments and plasters in the management 
of wounds, the constitutional treatment of local diseases, 
and the free external use of cold water, mark the pre- 
sent as a golden period of surgical science. 

The introduction of ether enabling us to perform 
operations, and apply remedies without pain, crowns 
all these improvements. What remuneration can be 
too great for such a discovery ! 

Should the Congress of the United States follow the 
generous policy of the British Parliament in similar 
cases, they would naturally institute an investigation 
into the facts connected with this discovery, and bestow 
a proper reward on whomsoever was found to merit it ; 
at the same time annulling the exclusive patent. 

While we would pay a willing and liberal tribute to 
the individual who has been made the instrument of 
this discovery, we should look higher for its author, 



88 



and elevate onr fervent attributions of praise and thanks- 
giving to Him who has been pleased, from the rich 
treasures of His goodness, to confer so wonderful a gift 
on our generation I 



APPENDIX 



A. 

The term ether, aether, is derived from the Greek 
word aid^Eiv, to consume ; signifying the element of 
fire situated in the highest region of heaven beyond 
the air. The date of the discovery of ether is uncer- 
tain ; for there are passages in the writings of some of 
the ancients which may be interpreted to refer to it, but 
not so explicitly as to render certain a knowledge of it 
by them. The oldest of these references is by Ray- 
mond LuUy, of the thirteenth century ; the second by 
Basil Valentine, of the fifteenth century. In the year 
1540, Valerius Cordus, of Nuremberg, describes, 
under the name of oleum vitrioli dulcey an ai'ticle 
approximating to very impure sulphuric ether ; the de- 
scription of which is transcribed, by Conrad Gessner, 
in 1552. 

The earliest period at which this fluid is distinctly 
mentioned by the name of ether, within our knowledge, 
is in an article by Mr. Godfrey, in the Transactions of 
9 * 



90 



the Royal Society of London for 1730, art. 8, p. 283, 
in whicli certain experiments witli it are detailed, and 
its refrigerating and inflammable nature spoken of. 
Although the writer appears to consider the discovery 
as originating from a German chemist, Frobenius, an 
assumed name it is supposed by Macquer; yet he 
speaks of some experiments with ether in the laboratory 
of his master, Boyle, at a previous date, and, in cor- 
roboration of the accuracy of his statement, refers to 
the works of Sir Isaac Newton, by whom it is styled 
Spiritus vini aethereus. 

This appears to be the first authentic account of ether 
and its properties. That sulphuric ether was the kind, 
employed, is evident from its mode of preparation, 
''equal parts, by weight, of vitriolic oil and spirits 
of wine." 

From the year 1730 the attention of chemists was 
much directed to ether. It was manufactured with 
difficulty, and in small quantities, until great facilities 
were introduced by Hellot, after whose time it has 
been abundantly made. At a subsequent period the 
labor of Baume, embracing as it does not only a 
chemical examination of the properties of ether, but 
also of the various other products resulting from the 
distillation of alcohol and sulphuric acid, was a great 
contribution to the chemical science of the time. 

From the analysis of Saussure, the composition of 
pure ether is found to be as follows : Carbon, 64.96 ; 
hydrogen, 13.47; oxygen, 21.57. 

The ethers are limpid, diaphanous fluids, of a highly 
volatile nature, and strong penetrating odour. They 



91 



are of different kinds, produced by the action of alco- 
hol with different acids; thus we have, besides the 
sulphuric, the acetic, nitric, muriatic, and chlorine 
ethers. A variety of the last of these, discovered by 
Mr. Guthrie, of this country, in consequence of an 
effort to manufacture the diluted chlorine ether of the 
Dutch chemists, on the recommendation of Professor 
Silliman, is esteemed as a mild, diffusible stimulant, 
constituting so pleasant a drink when diluted with 
water, as to have been used for purposes of intoxica- 
tion. The Spirits of Nitrous Ether, Hoffman's Ano- 
dyne Liquor, and Glutton's Febrifuge, are well-known 
preparations. 

The effects of nitric ether are more active than those 
of sulphuric. Both of them have been used internally 
for many years : their stimulating and very diffusible 
properties have, however, prevented their extensive 
employment, excepting in a modified state. They 
have also been used externally as refrigerants by evap- 
oration. The late Dr. Thatcher, of Plymouth, in 
Massachusetts, recommended the use of sulphuric ether 
in this way for the reduction of strangulated hernia. 

Mr. Robert FergTison, an enterprising chemist and 
apothecary of this city, has furnished me witli the fol- 
lowing formula for the preparation of sulphuric ether, 
as pursued at the Norfolk Laboratory, belonging to 
Messrs. Everett & Blake, and for some years under 
his charge : 

' ' Into a lead retort, introduce by small portions at a 
time, through the safety-tube (after the apparatus is 
luted together), ninety pounds of sulphuric acid, and 



92 



ninety pounds of strong alcohol. Raise the heat until 
it boils gently, and continue it so till sulphurous vapors 
appear at the orifice of the pipe proceeding from the 
receiver. The operation will require about one day. 
A second forty-five pounds of alcohol are added to the 
mass in the retort, and the distillation continued as 
before. On the third day the same quantity of alcohol 
is added, and the distillation continued. When cold, 
remove the residuum from the retort, and dilute with 
water, and preserve it for making the sulphate of 
potassa. Place the distilled liquor in closely stopped 
demijohns, and add thereto a small quantity of potassa, 
in order to remove the sulphurous acid with which it is 
contaminated ; agitate occasionally for two or three 
days, decant, and return it into the retort, which ought 
previously to be cleaned, as also the receiver and con- 
denser. Let the retort be carefully luted, and apply a 
moderate heat, not sufficient to produce boiling. 

*' The sulphuric ether in general use among drug- 
gists, contains more or less alcohol and water. It may 
be obtained pure by adding to it dry sub-carbonate of 
potassa, as long as it is wetted by the liquor ; decant- 
ing it, and adding dry muriate of lime. The carbonate 
in the first instance separates the water, and the alcohol 
is separated by the muriate of lime. In this manner I 
have obtained it of the specific gravity of .630 at 60® 
F. It is not in this state, however, perfectly pure, but 
contains a quantity of the salts, from which it may be 
freed by distillation^ though not without increasing the 
specific gravity." 

Ether thus prepared is proper for inhalation, and 



93 



we have been in the habit of employing it for this 
purpose. 

The mode of preparation recommended by Dr. 
Jackson, is as follows. The strongest and purest rec- 
tified sulphuric ether, which can usually be obtained 
from the druggists, is agitated with water, for the pur- 
pose of removing all acid. It is then freed from the 
water it may have taken up, by the chloride of calcium. 
Its specific gravity is thus rendered about .725. 



B. 

The opinion expressed in the text as to the compara- 
tive period of etherization of the cerebral lobes and the 
encephalic ganglia, differs from that of the able physi- 
ologist, Mons. Longet. Which of the two best ex- 
plains the phenomena must be decided by a careful 
observation of facts. In justice to Mons. Longet, it 
seems proper to present his views on this subject. In 
his opinion there are a certain class of cases, where, 
during the operation, the patient evinces the customary 
signs of pain, and appears to the by-standers to be 
undergoing the usual amount of suffering; and yet, 
when the operation is terminated, he declares that he 
has suffered no pain. It must be recognized that in 
these cases the etherization has been imperfect, extend- 
ing only to the cerebral lobes without reaching the 
cephalic ganglia. In such cases the pain must be 
allowed to have been felt, but not perceived — the 



94 



cries, groans, etc., were reflex actions from the centre 
where these sensations are received. The perception 
of these sensations did not take place, because the 
organ of perception, the cerebral lobes, was under the 
influence of ether. 

The recognition of this fact is of importance in a 
practical point of view. For if, as we suppose, there 
be reason to believe that the actual danger resulting 
from an operation is diminished by its being done with 
the patient under the complete influence of ether, inas- 
much as the nervous centres being dormant, the shock 
must necessarily be diminished, we must recognize that 
in this class of cases the shock to the nervous centres 
may be felt in its full force; — in fine, that the sensa- 
tion of pain may be as injurious as its perception, and 
is equally to be avoided. 

Mons. Longet, it appears, maintains the opinion, 
that in these cases of agitation and crying out the 
cerebral lobes are first etherized, while the annular pro- 
tuberance is not; therefore sensitiveness residing, as 
he thinks, in the latter is not abolished, but the cere- 
bral lobes being in an etherized state take no cogni- 
xance of the painful sensations. 

Now, in these cases of oblivion of pain, the cerebral 
lobes, the seat of intellect, being etherized, the intel- 
lectual functions should be suspended, according to 
him, which we know is not the fact in a number of in- 
stances. For in such cases^ when there are signs of 
existing sensitiveness, there are also signs of intellec- 
tual action ; the patient answers questions proposed to 
him, he also sees and hears. 



95 



C. 

This case not having terminated at the time the finst 
part of the description was in type, the remainder is 
inserted here. The stone was about half an inch long, 
the fourth of an inch thick, and in form of a flattened 
oval. It was sawn by Dr. J. B. S. Jackson. The 
exterior layer consisted of a whitish deposit, the six- 
teenth of an inch in thickness, and composed apparently 
of triple phosphate. The layers within this were of a 
brownish color, like that of the phosphate of lime, and 
were about half a line in thickness. In the midst of these 
was a harder substance, about a line in diameter, which 
appeared to be siliceous; its outline could not be 
exactly distinguished from the surrounding layer of 
brown deposit. The analysis was committed to Dr. 
Martin Gay, but was not accomplished in time to 
enable us to say, whether the constituents were cer- 
tainly the substances above indicated. 

The retrograde passage of the apparent nucleus into 
the bladder may excite surprise, unless we take into 
consideration the inverted action of the urethra, by 
which bodies received into it are so often conveyed 
from without into this organ, where they serve as the 
nuclei of stones. The introduction of this nucleus may 
receive an additional explanation from the fact, that the 
gravel-stone removed by the mother prevented the 
passage of urine forced into the urethra by the strong 
contractions of the bladder, and this not escaping, was 



96 



driven back by the contractions of the urethra, carry- 
ing along the inner stone which formed the nucleus. 

The protracted etherization left behind it no distin- 
guishable symptoms. The boy experienced a moderate 
invasion of fever, without any abdominal disturbance, 
or any remarkable local inflammation. The urine 
flowed through the penis on the second day, but the 
swelling about the urethra prevented its re-appearance 
for a week. Since then, it has gradually resumed 
its natural passage, and now passes wholly by the 
urethra, though the external wound is not entirely 
healed. With this exception, the boy is quite well, 
and on his feet. 

The bi-lateral operation employed in this instance, is, 
in my opinion, the safest and easiest, as I have stated 
in the American Journal of the Medical Sciences, 
and which, I am glad to find, has found favor with 
some able surgeons of the south and west. In the 
cases where I have employed it, the external wound 
has the disadvantage of healing more slowly than after 
the lateral operation. 



97 



CHLOEOFOEM. 



In the preceding part of these pages, we mentioned, 
among the other ethers, a preparation called chloric or 
chlorine ether. This, in its ordinary state, we used in 
the early stage of the practice of etherization, without 
any well marked effect. We have just learnt, that 
Professor Simpson, of Edinburgh, and Mr. Bell, of 
London, have employed this liquor in a concentrated 
state, as a substitute for sulphuric ether, in producing 
etherization ; and, as stated by the former gentleman, 
with more agreeable results. But the latter, although 
the first to use it, after making a number of trials, 
seems to have abandoned it, on account of the com- 
parative expensiveness. 

Professor Simpson says, that it acts in smaller quan- 
tity, more speedily, with less irritation of the lungs, 
more pleasant consequences, and that it has a fragrant 
smell. He thinks it will prove to be an excellent 
substitute for sulphuric ether. On employing this 
article, we have verified the properties ascribed to it 
by him, so far as to justify the conclusion, that it may 
10 



98 



be often used advantageonsly instead of siilpliurie ether. 
But we are not prepared to support its pretensions to 
become a substitute for tlie latter in general practice. 
"We shall, however, proceed to employ it, until a fair 
trial has been made of its properties, and be governed 
in its use by the result. 

There is one great advantag-e in this substance, that, 
being required in small quantity, it may be easily trans- 
ported ; and there is one great objection, that its ex- 
pensiveness must at present prevent its general use. 

We have employed it on a rag, as recommended by 
Professor Simpson, and also by a sponge, which has 
proved more satisfactory. But, considering its high 
cost, it seems better, contrary to the mode employed in 
administering sulphuric ether, to apply it by an inhaling 
apparatus, as by this mode it would not come in contact 
with the skin, and no unnecessary quantity would be 
used. 

Chloric Ether was prepared by Mr. Guthrie, in 
this country, in the year 1881. His mode, as stated in 
Silliman's American Journal of the Arts and Sciences, 
vol. xxi. was this : 

" Into a clean copper still, put three pounds of 
chloride of lime, and two gallons of well-flavored 
alcohol, of specific gravity .844, and distil. Watch 
the process, and when the product ceases to come over 
highly sweet and aromatic, remove, and cork it up 
closely in glass vessels. The remainder of the spirit 
should be distilled off for a new operation." 

This liquid was subsequently examined by Liebig 
and Dumas. By the former, Liebig, it has been styled 



99 



the PercMoride of Formyle, and the following method 
of preparing it given : 

" One part of hydrate of lime is suspended in twenty- 
four parts of water, and a current of chlorine gas is 
sent through the mixture until the greater part of the 
lime is dissolved, and a little milk of lime is added, to 
make the mixture alkaline. When the solution of 
chloride of lime has become clear by repose, one-twenty- 
fourth of its volume of alcohol is added; and, after 
being left to itself for twenty- four hours, the liquid is 
distilled by a gentle heat in a capacious retort. The 
product has an ethereal odour, and contains perchloride 
of formyle, mixed with alcohol. On shaking it, the 
perchloride separates as a dense liquid, and may be 
obtained perfectly pure by digesting it on chloride of 
calcium, and distilling it again with concentrated sul- 
phuric acid." 

By the latter, Dumas, on account of the relation of 
its composition to formic acid, it has been denominated 
Chloroform, and the following simple method for pro- 
curino; it sup:c!:ested : 

' ' Four pounds of chloride of lime are added to 
twelve pounds of water, and twelve fluid ounces of 
rectified spirit. This mixture is distilled as long as a 
dense liquid, which sinks in the water which it covers 
over, is produced." 

We are informed by Professor Simpson, that it can 
also be procured, "by making milk of lime, or an 
aqueous solution of caustic alkali, act upon chloral ; 
by distilling alcohol, pyroxylic spirit, or acetone, with 



rational and potent means, have been exemplified in such a 
lucid, impressive, and eloquent manner, that the theory and in- 
ductive practice cannot fail of being universally accredited and 
confidently adopted. Dr. Warren has rendered invaluable 
services to his country ; and his admirable compendium should 
be introduced into every family, academy and college, as the 
sanative manual of parents and instructors, for their guidance 
in conducting the physical education of their children and pu- 
pils, which is too generally utterly neglected. 



From the Daily Adveitiser. 

This little work deserves a more general notice than we 
have yet seen, for its peculiarly useful character, as well as for 
its delicacy of expression, and important teachings. Unlike 
most works upon health, it is neither voluminous nor expen- 
sive. The sound principles and directions it contains are con- 
densed in so interesting a manner as to render it an invaluable 
companion : while the clearness of typography and its beau- 
tiful appearance will constitute an ornament to any centre 
table. Our young men would do well to take heed to its doc- 
trines in respect to diet, the use of stimulants and tobacco. ^ =^ 
In short, it is one of those rare works which now and then 
appear, that ought to be in possession of every family through- 
out the land. 



From the Journal of Health. 

It embodies the experience of a long life in the practice of 
medicine and surgery. Nothing could have been more needed 
than such a book ; and the subjects on which it speaks are just 
what every man, woman and child should uaderstand. The 
first one named is physical education, upon which the com- 
munity need ''line upon line, and precept upon precept." 
Then follow the subjects of digestion, exercise, ^sleeping, use 
of water, friction, tobacco, and the conclusion. We rejoice to 
find these subjects discussed here with a degree of clearness, 
pathos, and precision seldom found, and backed by an expe- 
rience perhaps unequalled by any man in our country, in in- 
vestigating the human body, prescribing for its diseases, and 
administering to its accidents. 



From the Boston Atlas. 

All over the country this treatise has been hailed with mark- 
ed pleasui'e, and seems to be doing an inmiense amount ©f 



good. The American Journal of the Medical Sciences, pub- 
lished in Philadelphia, speaks of it in the highest terms ; and 
observes, with reference to its success, " that one of the most 
important missions of a true and enlightened physician is to 
point out to mankind the way to avoid the causes which en- 
gender disease, and to show them the necessity of giving heed 
to the warnings of mischief going on within themselves, ere 
complete derangement takes place, and to endeavor to con- 
vince them that the various parts and organs of their wonder- 
fully contrived body are generally fixed laws, which cannot be 
departed from, without sooner or later causing suffering and 
disease. Such is the aim of Dr. Warren's book on the preser- 
vation of health." The author has benefitted mankind by his 
judicious remarks, the soundness of whose doctrine is univer- 
sally admitted. 

From the Evening Transcript. 

The importance of a sound constitution, and of good health, 
is acknowledged by every one in the moment of sickness ; but 
when engaged in the active duties of life, we are too prone to 
neglect the proper measures to keep that soundness of body 
upon which a sound mind depends. A little work with the 
above title has recently appeared, from the pen of Dr. John C. 
Warren ; and it must be gratifying to every philanthropic per- 
son to find one of his experience pointing out to people in 
general the means of health. The work is invaluable — plain 
and concise in style; clear and firm in its teachings, it should 
be in possession of every family in the country. 

From Edward Everett^ President of Harvard University. 

Dr. J. C. Warren, My dear sir; — Allow me to return you 
my thanks for the copy you were so good as to give me of 
your " Essay on Physical Education, and the Preservation of 
Health." I have read it more than once with great pleasure. 
It appears to me to contain information of the highest im- 
portance on the structure and functions of the human frame 
and of the proper course to be pursued as to exercise and food, 
with a view to the prevention of those diseases, by which life 
is shortened in many cases, and in many more its enjoyment 
and usefulness are greatly impaired. 

Hoping that this little publication will be extensively read 
by the young of both sexes, who stand most in need of its les- 
sons, I remain, my dear sir, with the highest regard, faithfully 
youi'S, 

EDWARD EVERETT. 



From Professor Mussey^ of Cincinnati, Ohio. 

My dear sir ; — I am very glad to see your Essay on Healtli 
put in a form that will admit of its extensive circulation. The 
preservation of health, strange as the fact may seem, is one of 
the last to be studied, while every one gives a ready assent to 
the common place remark, that '' health is a great blessing, and 
■without it there can be but little enjoyment in this world." If 
all classes of society could be induced to attend in earnest to 
this subject, — to avail themselves of all the light within their 
reach, and practically to follow out well established hygienic 
principles, mankind would be released from a large proportion 
of their physical suffering. 

That your Essay may be generally read, and its valuable 
maxims put in practice, is the sincere desne of your friend, 

R. D. MUSSEY. 
To Dr. J. C. Warren. 



From Professor Dickson, of Charleston, South Carolina. 

John C. Warren, M. D.. My dear sir; — Your very pretty 
little volume on Hygiene has just come safely to hand — and 
the receipt of it is productive of very great pleasm^e to me. Eirst, 
from its intrinsic value as a code of laws whose importance is 
confirmed by the experience and observation of one of the old- 
est, wisest, and most eminent of our profession — and secondly, 
as a mark of courteous remembrance from one whom we all 
delight to honor. 

Receive my sincere acknowledgments, and believe me to be, 
with the highest esteem and respect, your obedient servant, 

SAMUEL HENRY DICKSON. 



From Hon. Judge White, of Salem, Mass. 

John C. Warren, M. D. — My dear sir ; — I thank you 
most heartily for your beautiful little volume on the " Preser- 
vation of Health " — which I have read mth great pleasure and 
satisfaction. It appears to me to be as good as it could be both 
in point of matter and style — condensing as it does the sound- 
est principles and dnections in so interesting a manner and 
with such delicacy of expression as must make it a welcome 
parlor companion in refined society, while it is a most valuable 

and useful one every where. 

j(, "jt. ^ ^ ^ 

•TT -TV" -TT "TT "TT 

With the highest regard, your obliged friend, 

D. A. WHITE. 




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